Hormone replacement therapy with tibolone: effects on sexual functioning in postmenopausal women

Egarter, Christian; Topçuoğlu, Ata; Vogl, Sonja; Sator, Michael

doi:10.1080/j.1600-0412.2002.810711.x

Cited by 9 publications

(7 citation statements)

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“…The use of tibolone, a synthetic corticosteroid, may also be considered. Studies in postmenopausal women have shown that it can enhance libido and mood and reduce vaginal dryness and consequent dyspareunia 15 …”

Section: Management Of Sexual Problemsmentioning

confidence: 99%

Older women's sexuality

Yee¹,

Sundquist

2003

Medical Journal of Australia

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SEXUAL PROBLEMS are relatively common in women, occurring in up to 43% of younger women 1 and increasing with age. 2 These result from an interaction of biological, psychological and social factors. 3 As the population in the Western world ages, there is more attention focused on quality-of-life issues as they affect older people. (In Australia, older people are defined as those aged over 65 years. 4 ) The proportion of older people who remain sexually active varies considerably with age, sex, marital status and general health. Estimates indicate that about 55% of married women over 60 years and up to 24% of married women over 76 years are sexually active. 5 In Australia, 12.4% of the population in 2001 was aged over 65 years, a proportion that is projected to rise to 21.3% by 2031. 6 As physicians, we are increasingly likely to see more sexual problems in older women as this present generation remains healthier and independent for longer.Sexual intimacy is an important aspect of human relationships, and sexual problems should be addressed as part of a holistic health assessment. However, doctors are often uncomfortable talking about sexuality, and the topic is often ignored in consultations with older patients. 7 While many doctors report that they would be willing to discuss sexuality if patients broached the subject, studies indicate that most older women patients will be hesitant to do so. As these women grew up in a generation in which sex and sexuality were rarely discussed, the onus of initiating discussion of sexual issues often rests with the doctor. Physical causes of sexual problemsPhysical problems associated with hormonal changes and acute and chronic illness become more prevalent later in life. These inevitably affect a woman's physical wellbeing and may alter her sexual response or ability to physically engage in intercourse. 8 Physical causes of sexual problems in older women include: 9 ■ hormonal changes (Box 1); ■ vascular disorders (eg, high blood pressure, high cholesterol levels, heart disease); ■ diminished pelvic blood flow, secondary to ageing, trauma or surgery; ■ atherosclerotic disease causing vaginal wall and clitoral smooth muscle fibrosis; ■ neurological disorders (eg, spinal cord injuries, diseases of the central or peripheral nervous system); ■ side effects of drugs such as antidepressants, ␤-blockers, antipsychotics, anticholinergics; ■ effects of alcohol or recreational drugs; and ABSTRACT ■ In consultations with older women, doctors should ask about sexual problems. A holistic approach is needed to examine the many different factors that can affect sexuality.■ Hormonal changes associated with ageing have an impact on women's sexuality. Doctors need to have a clear idea of the place of hormonal treatment for different sexual problems.■ Physical changes associated with ageing, including illness and disability, may interfere with sexual expression. Diseases of the endocrine, vascular and nervous systems will most commonly affect sexual function.■ A broad range of psychosocial facto...

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Section: Management Of Sexual Problemsmentioning

confidence: 99%

Older women's sexuality

Yee¹,

Sundquist

2003

Medical Journal of Australia

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“…In two placebo-controlled studies with tibolone, an improvement not only regarding dyspareunia but also sexual enjoyment and libido was found 15,16 . A recent study 17 using vaginal plethysmography has demonstrated that the use of tibolone improves vaginal blood flow, suggesting that the enhancement in sexuality with tibolone may be attributable to both central and peripheral effects 18 . The D4-isomer of tibolone is formed either from tibolone directly or from the 3b-OH-metabolites.…”

Section: Discussionmentioning

confidence: 99%

Effect of different preparations of hormone therapy on sexual dysfunction in naturally postmenopausal women

et al. 2006

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“…9 We thank Richard Santen and Henry Burger for their review of the manuscript and advice about the risks and benefits of HRT.…”

Section: For Atrophic Vaginitismentioning

confidence: 99%

Hormone replacement therapy

Hickey

Elliott

Davison

2012

BMJ

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This is one of a series of occasional articles on therapeutics for common or serious conditions, covering new drugs and old drugs with important new indications or concerns. The series advisers are Robin Ferner, honorary professor of clinical pharmacology, University of Birmingham and Birmingham City Hospital, and Philip Routledge, professor of clinical pharmacology, Cardiff University. To suggest a topic for this series, please email us at practice@bmj.com.A 51 year old woman presents to her general practitioner with troublesome hot flushes and night sweats for the past eight months. She is sexually active and her last period was about 5 months ago. She has taken a number of over-the-counter preparations, but none have been effective. She is anxious about having hot flushes at work and exhausted from sleep disturbance. She wants advice about managing her symptoms. What is hormone replacement therapy?Menopause is a normal physiological event in women, occurring at a median age of 51 years. Hormone replacement therapy (HRT) contains oestrogen for relieving menopausal symptoms; for women who still have their uterus it is combined with a progestogen for endometrial protection. The oestrogen (oestradiol, oestradiol 17β, oestrone, or conjugated equine oestrogen) can be oral, intravaginal, or transdermal. The progestogen can be oral, transdermal, or delivered via an intrauterine device (Mirena, Bayer Schering). In HRT regimens the oestrogen is taken daily, with progestogen added either sequentially (cyclic regimen) or daily (continuous combined regimen) if it is needed. 1 Tibolone is an oral synthetic steroid preparation with oestrogenic, androgenic, and progestogenic actions that can also be used as HRT. Testosterone can be added to HRT, but the role of supplemental testosterone will not be covered in this case.The key indication for HRT or tibolone is the presence of troublesome vasomotor symptoms (hot flushes and night sweats, with or without awakening). Vasomotor symptoms are normal and affect about 80% of women during the menopause transition and are severe in about 20% of these women. The duration of these symptoms varies, with a median of four years, but may continue for as many as 12 years in about 10% of women. 2 HRT may be indicated when menopausal symptoms are adversely affecting quality of life. How well does HRT work?HRT is currently the most effective treatment for troublesome vasomotor symptoms. A systematic review showed a significant mean reduction in the frequency of hot flushes by around 18 a week and in the severity of hot flushes by 87% compared with placebo. 3 Large randomised controlled trials have confirmed that HRT also significantly reduces fracture risk, improves vaginal dryness and sexual function, and may also improve sleep, muscle aches and pains, and quality of life in symptomatic women. 4 5 The figure⇓ provides the estimated absolute benefits from HRT use in postmenopausal women aged 50-59 years or <10 years after menopause, based on background risk in American women, 6 using data from t...

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Hormone replacement therapy with tibolone: effects on sexual functioning in postmenopausal women

Cited by 9 publications

References 0 publications

Older women's sexuality

Older women's sexuality

Effect of different preparations of hormone therapy on sexual dysfunction in naturally postmenopausal women

Hormone replacement therapy

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