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Sexual activity and vaginal symptoms in the postintervention phase of the Women's Health Initiative Hormone Therapy Trials

Gass, Margery MD1; Larson, Joseph MS2; Cochrane, Barbara PhD, RN2,3; Manson, JoAnn E. MD, DrPH4; Lane, Dorothy MD, MPH5; Barnabei, Vanessa MD, PhD6; Ockene, Judith PhD, MEd, MA7; Stefanick, Marcia L. PhD8; Mouton, Charles MD, MS9

doi: 10.1097/GME.0000000000000994
Original Articles

Objective: To assess the impact of discontinuing oral hormone therapy (HT) on sexual activity, vaginal symptoms, and sexual activity components among participants in the estrogen-progestin therapy (EPT) and estrogen therapy (ET) trial of the Women's Health Initiative.

Methods: Surveys were sent postintervention to those who were still taking study pills and agreed to continue in the study when the trials were stopped. Comparisons between former HT and placebo users were accomplished with chi-square tests for categorical variables and t tests for continuous variables.

Results: In all, 13,902 women with mean age at survey 69.9 years (EPT trial, women with intact uterus) and 71.7 years (ET trial, women with history of hysterectomy) responded. Prevalence of sexual activity postintervention was not significantly different between former EPT and placebo users (36.0% vs 34.2%; P = 0.37). Sexual activity of former ET users was 5.6% higher than placebo users (27.6% vs 22.0%; P = 0.001). The majority of sexually active women overall maintained orgasmic capacity and sexual satisfaction. Former EPT users were 10% to 12% more likely than former placebo users to report decreased desire, arousal, intercourse, climax, and satisfaction with sexual activity, and also increased dryness and dyspareunia upon discontinuing study drugs (P < 0.001). Former ET users were more likely than placebo users to report rare to no desire or arousal postintervention (P < 0.001).

Conclusions: Postintervention ET trial participants formerly assigned to ET were significantly more likely to report sexual activity than those formerly assigned to placebo. Women who discontinued EPT were significantly more likely to report negative vaginal and sex-related effects.

1Cleveland, OH

2Fred Hutchinson Cancer Research Center, Seattle, WA

3University of Washington School of Nursing, Seattle, WA

4Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA

5Department of Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY

6Department of Obstetrics and Gynecology, School of Medicine and Biomedical Sciences, University at Buffalo, New York, NY

7Division of Preventive and Behavioral Medicine at the University of Massachusetts, Worcester, MA

8Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA

9Office of Academic Affairs and Department of Family Medicine, University of Texas Medical Branch, Galveston, TX.

Address correspondence to: Margery Gass, MD, 4 Salem Court, Cleveland, OH 44122. E-mail:

Received 7 July, 2017

Revised 5 September, 2017

Accepted 5 September, 2017

Funding/support: The Women's Health Initiative program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services. The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through contracts HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, and HHSN268201600004C.

Financial disclosure/conflicts of interest: None reported.

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© 2018 by The North American Menopause Society.