Is Estrogen Useful in Low Libido or Arousal Problems?

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