Do high‐dose progestins impair sexual function in women treated for endometriosis? A prospective observational longitudinal study

Abstract

Introduction High‐dose progestins are used as an effective therapy for painful symptoms of endometriosis but their impact on sexual function has been poorly studied. The study aims to assess the impact of high‐dose progestin on sexual function among women treated for endometriosis. Material and methods In this bicenter prospective observational study, women with endometriosis who received medical or surgical treatment for endometriosis and who were sexually active were included. They completed the Sexual Activity Questionnaire (SAQ, a validated tool) before (T0) and 12 months after (T1) endometriosis treatment. We classified patients into two groups according to whether they were using high‐dose progestins at T1: a high‐dose progestin group and a control group. The main outcome was sexual function measured by the SAQ score (from 0 to 30) at T1. The secondary outcomes were each individual SAQ item, the dyspareunia 100‐mm visual analog scale (VAS) and the quality of life assessed with EuroQoL Group 5D Index (EQ‐5D) at T1. We also assessed the change in dyspareunia VAS and quality of life between T0 and T1. The Ethics Committee of Ile‐de‐France (Act 2004‐806, 9 August 2004) approved the study. Results Among 214 women included, 25 (12%) were exposed to high‐dose progestins at T1. The SAQ score of women exposed to high‐dose progestins was significantly lower compared with the control group, with or without adjustment for covariates (15.5 ± 6.3 vs 18.3 ± 6.2, P = .03, adjusted effect size −0.44 [95% CI −0.86 to −0.02], P = .04). High‐dose progestin intake at T1 was associated with a lower subscore on two SAQ items: pleasure (1.8 ± 0.8 vs 2.2 ± 0.9, P = .02), and satisfaction with frequency of intercourse (1.2 ± 1.2 vs 1.8 ± 1.1, P = .02). In the overall population, dyspareunia VAS and quality of life assessed by EQ‐5D improved between T0 and T1 (45 ± 29 at T0 vs 28 ± 29 at T1, P < .001; 0.78 ± 0.14 at T0 vs 0.86 ± 0.14 at T1, P < .001, respectively). At T1, the groups did not differ significantly for dyspareunia VAS (effect size 0.36 [95% CI −0.06 to 0.78], P = .10) and quality of life (EQ‐5D, effect size 0.02 [95% CI −0.40 to 0.44], P = .91). Conclusion In this observational study, high‐dose progestins impair the sexual function of women treated for endometriosis even though they improved dyspareunia.

An evaluation of sexual function and health-related quality of life following laparoscopic surgery in individuals living with endometriosis

“…The use of the minimum clinically important difference allows for a closer focus on the domain of concern for the patient and can be used to guide symptom management ( Thirlaway et al , 1996 ). Consistent with the aim of the current study to explore overall sexual function rather than limiting the scope to the experience of dyspareunia, Oppenheimer et al (2024) argue that the selected sexual function measure must account for the entire sexual response cycle and not be isolated to measurement of pain during penetration alone. While the FSFI does allow for an assessment of the full sexual response cycle, further development of endometriosis-specific scoring norms is recommended.…”

“…A recent systematic review conducted by Oppenheimer et al (2024) has found that while the FSFI can be used to discriminate between endometriosis subtypes and has efficacy in evaluating outcomes associated with medical treatment, it may lack specificity for measuring surgical outcomes and low scores may not necessarily be solely reflective of the impacts of endometriosis. In contrast, the use of the Sexual Activity Questionnaire (SAQ: Thirlaway et al , 1996 ) was noted to have good responsiveness for measuring surgical outcomes in the domains of pleasure and discomfort, has been validated in an endometriosis sample, and allows for a measure of clinically important difference ( Oppenheimer et al , 2024 ). The use of the minimum clinically important difference allows for a closer focus on the domain of concern for the patient and can be used to guide symptom management ( Thirlaway et al , 1996 ).…”

Measurement properties of sexual function assessment questionnaires in women with endometriosis: A systematic review following COSMIN guidelines

“…Unidimensionality is an interesting property for clinician use in everyday practice to monitor the effect of the treatment of endometriosis on sexual function. 88 A third questionnaire, the SHOW-Q distinguished itself by good measurement properties for "hypothesis" and "responsiveness," although it is less frequently used.…”

“…One interesting property is that it is unidimensional, 20 which facilitates the calculation and use of the score. Unidimensionality is an interesting property for clinician use in everyday practice to monitor the effect of the treatment of endometriosis on sexual function 88 …”

Radical surgery for pseudo-ovarian malignancy: a case report of bowel endometriosis with massive ascites

“…She refused oral medication after surgery, but strongly desired for pain relief and recurrence prevention. Considering high-dose progestin contributes to recurrence prevention and dysmenorrhea relief (25,26), two intrauterine devices and subdermal implants were applied after multidisciplinary consultation and the total dose of levonorgestrel (130 μg/day) was reported to be safe (27).…”