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A randomized comparative study of the effects of oral and topical estrogen therapy on the vaginal vascularization and sexual function in hysterectomized postmenopausal women

Long, Cheng-Yu MD1,2; Liu, Cheng-Min MD1; Hsu, Shih-Cheng MD1,3; Wu, Chin-Hu MD3; Wang, Chiu-Lin MD2; Tsai, Eing-Mei MD, PhD1,3

doi: 10.1097/01.gme.0000227401.98933.0b
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Objective: To compare the effects of oral and vaginal estrogen therapy (ET) on the vaginal blood flow and sexual function in postmenopausal women with previous hysterectomy.

Design: Fifty-seven women were randomized to receive either oral (0.625 mg of conjugated equine estrogens per tablet; n = 27) or topical (0.625 mg conjugated equine estrogens per 1 g vaginal cream; n = 30) estrogen administered once daily. All women underwent estradiol measurements, urinalysis, pelvic examination, introital color Doppler ultrasonographies, and personal interviews for sexual symptoms using a validated questionnaire before and 3 months after ET.

Results: A higher serum level of estradiol was noted in the oral group compared with the topical group after 3 months of ET. There were significant increases in the number of vaginal vessels and the minimum diastole (P < 0.01), and marked decreases of pulsatility index values (P < 0.01) in both groups after ET. Regarding the systolic peak, we found a significant decrease only in the topical group (P < 0.05). Although the post-ET prevalence of anorgasmia decreased significantly in both groups (P < 0.05), changes in other domains, including the rates of low libido and coital frequency, were not statistically significant (P > 0.05). In the topical group, ET improved sexual function on the vaginal dryness and dyspareunia domains in a statistically significant manner (P < 0.05), but this was not the case in the oral group (P > 0.05). However, the efficacy of oral ET for vaginal dryness and dyspareunia reached 80% and 70.6%, respectively. The corresponding figures of the topical ET were 79.2% and 75%.

Conclusions: The results of our study suggest that ET alone in hysterectomized postmenopausal women increases the vaginal blood flow and improves some domains of sexual function, but it may not have an impact on diminished sexual desire or activity. Compared with systemic therapy, topical vaginal preparations are found to correlate with better symptom relief despite the lower serum level of estradiol.

Compared with systemic therapy, topical estrogen preparations used by postmenopausal women who have had a hysterectomy are found to correlate with better relief of sexual symptoms despite the lower serum levels of estradiol.

From the 1Department of Obstetrics and Gynecology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 2Department of Obstetrics and Gynecology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; and 3Department of Obstetrics and Gynecology, Kaohsiung Medical University, Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.

Received December 5, 2005; revised and accepted January 31, 2006.

This study was supported by grants from the National Science Council of the Republic of China (NSC 92-2314-B-037-111).

Address correspondence to: Eing-Mei Tsai, MD, PhD, Department of Obstetrics and Gynecology, Kaohsiung Municipal Hsiao-Kang Hospital, 482 Shan-Ming Road, Hsiao-Kang District 812, Kaohsiung, Taiwan. E-mail: K83263@kmhk.kmu.edu.tw.

©2006The North American Menopause Society