Sexual Health

CMECNE

Is Estrogen Useful in Low Libido or Arousal Problems?

Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. Classify those symptoms which have been demonstrated to respond to estrogen and those which have not
2. Choose the use of estrogen for appropriate symptoms

Estimated time to complete activity: 0.25 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.

The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.

Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Jan 25 2023, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.

Read Disclaimer & Fine Print

A patient complains of low libido or problems with arousal and is concerned that these might be a side effects of diminishing estrogen.

CLINICAL ACTIONS:

Assess the sexual concerns
If the sexual problems appear to be secondary to menopausal complaints associated with low levels of estrogen, consider prescribing estrogen
If sexual problems appear to be independent of other menopausal complaints, inform patient that there is currently limited evidence to suggest estrogen replacement helps with low libido or sexual arousal disorders
See ‘Related ObG Topics’ for other options to address low libido

SYNOPSIS:

Postmenopausal patients may be concerned that their lack of sexual desire is related to the lack of estrogen associated with menopause. Despite popular media suggesting otherwise, current research does not support the theory that prescribing estrogen for sexual concerns is recommended. However, in those cases where sexual concerns appear to be secondary to other issues of discomfort associated with menopause such as hot flushes, sleep disruption or vaginal atrophy, prescribing estrogen may be helpful.

KEY POINTS:

Evidence to date to remains limited as to whether estrogen plays a significant role in female sexual functioning
A recent study demonstrated transdermal estrogen provides modest improvement in sexual function in healthy, recently menopausal women (Kronos Early Estrogen Prevention Study [KEEPS] published in JAMA Internal Medicine, 2017 – see ‘Related ObG Topics’ below)
A comprehensive history and physical is helpful to determine if the patient’s complaint is stemming from other menopausal symptoms where systemic estrogen may actually be appropriate, for example exhaustion and sleep disorders related to hot flashes or vaginal atrophy leading to pain on intercourse
Testosterone may be considered in those cases where the physician and patient are looking for direct medical intervention for low libido or arousal problems
- Transdermal testosterone has been shown to be effective for the short-term treatment but minimal evidence exists for long-term use (longer than 6 months)
- Testosterone for use in hypoactive sexual desire disorder in women is not currently FDA approved

Learn More – Primary Sources:

Role of Estrogens and Estrogen-Like Compounds in Female Sexual Function and Dysfunction

ACOG Practice Bulletin 213: Female Sexual Dysfunction

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