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Hormones and Sexuality During Transition to Menopause

From the Departments of ¹Obstetrics/Gynecology and ²Psychiatry, ³Division of Reproductive Endocrinology and Infertility, ⁴Biostatistics and Epidemiology and Center for Clinical Epidemiology, and ⁵Center for Research in Reproduction and Women's Health, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.

OBJECTIVE: To examine the relationship between reproductive hormonal dynamics and sexual dysfunction assessed in a cohort of women approaching menopause.

METHODS: Women in the Penn Ovarian Aging Study were assessed at yearly intervals for 3 years with early follicular hormone measurements (estradiol, follicle-stimulating hormone, luteinizing hormone [LH], sex hormone binding globulin, dehyroepiandrosterone sulfate [DHEAS], total testosterone), anthropometric measures, and extensive questionnaires including the Female Sexual Function Index. Univariable analyses were performed to determine the association between hormones, menopausal status, and sexual dysfunction. Multivariable linear and logistic regression models were created to examine the influence of hormones on sexual function adjusting for the effect of potential confounders.

RESULTS: The final multivariable model indicated that sexual dysfunction increased with advanced menopausal status, with postmenopausal women being 2.3 times as likely to experience sexual dysfunction compared with premenopausal women (odds ratio 2.3, 95% confidence interval [CI] 1.3–4.1). Low DHEAS serum concentrations were associated with decreased sexual function (odds ratio 1.59, 95% CI 1.19–2.14). Additional risk factors associated with sexual dysfunction included absence of a sexual partner (11.2, 95% CI 6.9–18.1), high anxiety (3.8, 95% CI 1.6–9.2), and children under the age of 18 living at home (1.6, 95% CI 1.1–5.5). Lubrication, orgasm, and pain were specific aspects of sexuality negatively affected by menopause.

CONCLUSION: This study confirms the observation that sexual dysfunction increases over the menopausal transition. Several factors associated with sexual dysfunction include low DHEAS, absence of a sexual partner, anxiety, and children under the age of 18 living at home.

LEVEL OF EVIDENCE: II

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