Hypoactive sexual desire disorder in postmenopausal women: is there a relation with hormone replacement therapy and sex steroid hormonal levels?

Abstract

To investigate whether there is an association between hormone replacement therapy (HRT), serum hormonal levels and the prevalence of Hypoactive Sexual Desire Disorder (HSDD) in postmenopausal women. Cross-sectional study. Women attending outpatient gynecologic clinic completed questionnaires evaluating sexual function. These included the Brief Index of Sexual Functioning, the Profile of Female Sexual Function, and the Personal Distress Scale. The participants' serum levels of estradiol, androgens, and sex hormone binding globulins (SHBG) were determined. The main outcomes measured were the demographics of the interviewees, the impact of hurricane Katrina, HRT use, presence of HSDD, and hormone levels. Student's t, chi-square, and ANOVA tests were used. Odds ratios (OR) were calculated using the Cochran-Mantzel-Haenszel test. An α = 0.05 and a power of 80% were used. All analysis were performed using SAS version 9.0. TableStudy Participants and HRTHRT (n)No HRT (n)Race∗∗ White3524 Non-White411Age 30–49188 50–591622 >6055BMI (Kg/m2)∗∗ 18.5–24.92310 25–29.9610 >30914Katrina PreKatrina76 PostKatrina3229Menopause type∗ Natural1327 Surgical268Clinical history∗ Prior hysterectomy3313 Prior oophorectomy2721HSDD HSDD1714 No HSDD2221∗ P<0.005; ∗∗ P<0.05. Open table in a new tab ∗ P<0.005; ∗∗ P<0.05. Seventy five menopausal women, ages 32 to 66 years, were recruited from two clinics in New Orleans and Houma. HRT use was more common in women who were White (60% vs. 27% in non-Whites, P=0.049), younger than 50, had oophorectomies (69% vs. 31%, P=0.0002), had a hysterectomy (85% vs.15%, P<0.0001), or had a normal body mass index (BMI) (59% vs.15% in overweight and 23% in obese, P=0.029). The majority of women on HRT were using estrogen alone (ERT) (84%). ERT users had a significantly higher SHBG (P<0.05). They also had a higher estradiol level and a lower percent free testosterone, although not statistically different. The use of HRT was not associated with HSDD (OR = 1.16; CI 0.46–2.93). Furthermore there were no differences in hormone levels among women affected with HSDD. This study confirms that HSDD cannot be correlated to sex hormone levels and is not affected by HRT use. Although they had a higher SHBG, ERT users did not have a higher prevalence of HSDD. The elevated SHBG level, which is associated with a lower bioactive androgen, seems to be counterbalanced by an elevated estradiol that has a positive impact on the vagina. This reflects the multifactorial etiology of sexual dysfunction.