Hormone therapy in menopausal women with cognitive complaints PERCEIVED EFFECTS OF TESTOSTERONE REPLACEMENT THERAPY IN PERIMENOPAUSAL AND POSTMENOPAUSAL WOMEN: AN INTERNET PILOT STUDY Managing menopause. Comparison of the effects of hormone therapy regimens, oral and vaginal estradiol, estradiol + drospirenone and tibolone, on sexual function in healthy postmenopausal women. Aerobic exercise as a treatment for vasomotor menopausal symptoms: randomised controlled trial protocol. Ineffectiveness of Sertraline for Treatment of Menopausal Hot Flushes: A Randomized Controlled Trial The effect of hormone therapy on women's quality of life in the first year of the Estonian Postmenopausal Hormone Therapy trial Perimenopausal androgen decline after oophorectomy does not influence sexuality or psychological well-being. The effects of postmenopausal hormone therapy on social activity, partner relationship, and sexual life – experience from the EPHT trial [Clinical effects of hormone replacement therapy with estradiol valerate and cyproterone acetate in perimenopausal women]. Estrogen effects on the vaginal pH, flora and cytology in late postmenopause after a long period without hormone therapy. Raloxifene and Estrogen Effects on Quality of Life in Healthy Postmenopausal Women: A Placebo‐Controlled Randomized Trial Effectiveness of a low dose testosterone undecanoate to improve sexual function in postmenopausal women A longitudinal study of the perimenopausal transition: altered profiles of steroid and pituitary hormones, SHBG and bone mineral density. Effect of different preparations of hormone therapy on sexual dysfunction in naturally postmenopausal women Perimenopausal women in estrogen vasomotor trials: contribution to placebo effect and efficacy outcome Effectiveness of a modified version of the applied relaxation technique in treatment of perimenopausal and postmenopausal symptoms The benefits of androgens combined with hormone replacement therapy regarding to patients with postmenopausal sexual symptoms. The Enhancement of Female Sexual Function with ArginMax, a Nutritional Supplement, Among Women Differing in Menopausal Status Effects of the addition of methyltestosterone to combined hormone therapy with estrogens and progestogens on sexual energy and on orgasm in postmenopausal women Histologic classification and pathologic findings for endometrial biopsy specimens obtained from 2964 perimenopausal and postmenopausal women undergoing screening for continuous hormones as replacement therapy (CHART 2 Study). Estrogen and estrogen-androgen replacement in postmenopausal women dissatisfied with estrogen-only therapy. Sexual behavior and neuroendocrine responses. Bone mineral density at menopause does not predict breast cancer incidence
Objective : To evaluate the effects of hormone therapy ( HT ) on cognition and subjective quality of life ( QoL ) in recently postmenopausal women with cognitive complaints . Methods : Cognitive Complaints in Early Menopause Trial ( COGENT ) was a r and omized , double-blind , placebo-controlled , multicenter , pilot study of 180 healthy postmenopausal women aged 45 to 55 years , r and omly assigned to receive either placebo or conjugated equine estrogen 0.625 mg/medroxyprogesterone acetate 2.5 mg for 4 months . Outcome measures included memory , subjective cognition , QoL , sexuality , and sleep , which were assessed at baseline and month 4 . Results : The study was terminated before the expected final sample size of 275 due to a decrease in enrollment coinciding with the publication of findings from the Women ’s Health Initiative . There were no differences between groups on any cognitive or QoL measures , except for an increase in sexual interest and thoughts with HT . Modest negative effects on short- and long-term verbal memory approached significance ( p < 0.10 ) . Women with baseline vasomotor symptoms ( VMS ) showed a decrease in VMS and an improvement in general QoL , but no cognitive benefit vs placebo . Conclusions : With the power to detect an effect size of ≥0.45 , this study suggests potential modest negative effects on verbal memory that are consistent with previous hormone therapy trials in older women . GLOSSARY : BTA = Brief Test of Attention ; BVRT = Benton Visual Retention Test ; COGENT = Cognitive Complaints in Early Menopause Trial ; CRT = Educational Testing Service Card Rotation Test ; CVLT = California Verbal Learning ; FAS = Letter Fluency Test ; HERS = Heart and Estrogen/progestin Replacement Study ; HT = hormone therapy ; MFSQ = McCoy Female Sexuality Scale Question naire ; MFQ = The Memory Functioning Question naire ; PANAS = Positive and Negative Affect Scale ; PSQI = The Pittsburgh Sleep Quality Index ; QoL = subjective quality of life ; SWAN = Study of Women ’s Health Across the Nation ; UQoL = Utian Quality of Life ; VMS = vasomotor symptoms Test ; WHI = Women ’s Health Initiative ; WHISCA = WHI Study of Cognitive Aging ; WMS-R/DGT-F , MS-R/DGT-B = Digit Span Forward and Backward Subtests of the Wechsler Memory Scale – Revised Women experience somatic , mood , energy , and libido changes during menopause .  Testosterone replacement therapy is being prescribed in conjunction with estrogen replacement therapy ( ERT ) for these symptoms . Little is known about women ’s perceptions of the benefits and risks of testosterone , so an Internet survey was conducted to elicit women ’s perceptions of the effects on mood , energy , sexuality , and somatic symptoms .  A sample of 61 women primarily from the United States and Canada participated in the survey ; one woman from Germany and one from Sweden also took part in the survey . Participants reported significantly improved sexuality and improved mood and vigor , with a decline in fatigue . Of the 7 somatic complaints assessed , improvements were noted in 5 ( sleep disturbances , hot flashes , night sweats , vaginal dryness , and appetite ) . A prospect i ve clinical trial is needed to confirm these results OBJECTIVE To provide up date d guidelines for health care providers on the management of menopause in asymptomatic healthy women as well as in women presenting with vasomotor or urogenital symptoms and on considerations related to cardiovascular disease , breast cancer , urogynaecology , and sexuality . OUTCOMES Lifestyle interventions , prescription medications , and complementary and alternative therapies are presented according to their efficacy in the treatment of menopausal symptoms . Counselling and therapeutic strategies for sexuality concerns in the peri- and postmenopausal years are review ed . Approaches to the identification and evaluation of women at high risk of osteoporosis , along with options for prevention and treatment , are presented in the companion osteoporosis guideline . EVIDENCE Published literature was retrieved through search es of PubMed and The Cochrane Library in August and September 2012 with the use of appropriate controlled vocabulary ( e.g. , hormone therapy , menopause , cardiovascular diseases , and sexual function ) and key words ( e.g. , hormone therapy , perimenopause , heart disease , and sexuality ) . Results were restricted to clinical practice guidelines , systematic review s , r and omized control trials/controlled clinical trials , and observational studies . Results were limited to publication date s of 2009 onwards and to material in English or French . Search es were up date d on a regular basis and incorporated in the guideline until January 5 , 2013 . Grey ( unpublished ) literature was identified through search ing the websites of health technology assessment and health technology assessment -related agencies , national and international medical specialty societies , and clinical practice guideline collection INTRODUCTION Sexual dysfunction is more prevalent in postmenopausal women . AIMS To prospect ively evaluate and compare the effects of hormone therapy ( HT ) regimens , oral and vaginal estradiol , estradiol + drospirenone and tibolone , on  sexual function in healthy postmenopausal women . METHODS The study included 169 consecutive healthy postmenopausal women , and the women were divided into two groups : 111 women received HT , and 58 women received no treatment and served as a control group . As an HT , 23 women with surgically induced menopause received oral 17-beta estradiol . The rest of the women with natural menopause were prospect ively r and omized : 22 received oral 17-beta estradiol + drospirenone daily , 42 received oral tibolone , and 24 received vaginal 17-beta estradiol .  Sexual function was evaluated with a detailed 19-item question naire , the female sexual function index , including sexual desire , arousal , lubrication , orgasm , satisfaction , and pain . MAIN OUTCOME MEASURES The differences in sexual function were compared before and 6 months after the treatment in all women . RESULTS Total sexual function score increased from 19.81 + /- 7.15 to 22.9 + /- 6.44 in the HT group and decreased from 21.6 + /- 8.69 to 17.6 + /- 5.7 in the control group , revealing a significant difference from baseline to post-treatment between the two groups ( P = 0.000 ) . The highest improvement in total score and arousal was achieved with the oral 17-beta estradiol ( P = 0.000 and P = 0.000 , respectively ) . The highest improvement in lubrication was achieved with the oral and vaginal 17-beta estradiol groups ( P = 0.000 ) . The highest improvement in orgasm was achieved with the tibolone group ( P = 0.000 ) . The highest improvement in pain was achieved with the oral and vaginal 17-beta estradiol groups ( P = 0.000 ) . CONCLUSIONS HT provided significant improvement in sexual function compared to women receiving no treatment , and therefore , HT regimens should be suggested for improvement in sexual functioning of postmenopausal women BACKGROUND Evidence suggests that a high proportion of perimenopausal and postmenopausal women experience vasomotor symptoms ( hot flushes/night sweats ) that can be severe and disruptive and which are the principal reason for seeking medical intervention . Hormone therapy ( HT ) is known to be an effective treatment for troublesome hot flushes/night sweats but research has raised questions about the safety of HT and there have been negative high profile media reports about its use . Consequently many women are seeking alternatives and exercise might be one such option but there is a lack of high quality evidence on its effectiveness . AIMS This RCT initially aims to investigate the feasibility/acceptability of two exercise interventions identified from our previous preference study in 165 women , and if found to be feasible/acceptable , continue to recruit sufficient women ( n=261 ) to examine the effect of these interventions on hot flushes/night sweats and other outcomes relevant to menopausal women . METHOD We aim to recruit inactive perimenopausal and menopausal symptomatic women not using HT and r and omise them to one of two exercise interventions or usual care for six months . RESULTS We will assess outcomes at baseline and 6 and 12 months from r and omisation . CONCLUSION We hope this RCT will contribute towards increasing the evidence regarding the question of whether exercise is an effective treatment for vasomotor symptoms in women not taking HT OBJECTIVE : To estimate the effect of the selective serotonin reuptake inhibitor sertraline on hot flush frequency and severity in perimenopausal and postmenopausal women . METHODS : We performed a r and omized , blinded , placebo-controlled trial in women aged 40 to 60 years with 14 or more hot flushes per week ( N=99 ) . Women were r and omly assigned initially to daily oral sertraline ( 50 mg ) or identical placebo for 2 weeks . If no substantial side effects were noted , the dose was increased to two tablets daily ( 100 mg sertraline or placebo ) and continued for an additional 4 weeks . Hot flush frequency and severity were recorded on a daily diary . Hot flush score was calculated as frequency multiplied by severity . Participants also completed question naires addressing quality of life , menopausal symptoms , sleep quality , sexual function , mood , and side effects . RESULTS : After 6 weeks of treatment , hot flush frequency decreased similarly in both the placebo ( 38 % ) and sertraline ( 39 % ) groups ( P=.94 ) . Mean hot flush scores also decreased similarly in both groups ( 41 % and 42 % , respectively , P=.86 ) . Compared with placebo , women in the sertraline group were more likely to report gastrointestinal complaints , dry mouth , and dizziness . Treatment with sertraline also result ed in greater worsening of scores on the Medical Outcomes Study ( MOS ) Short Form 36 st and ardized physical component and the global Female Sexual Function Index . Results were similar in women at least 80 % adherent to study medication . CONCLUSION : Treatment with sertraline did not improve hot flush frequency or severity in generally healthy perimenopausal and postmenopausal women , but was associated with bothersome side effects . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00283192 LEVEL OF EVIDENCE : Background For postmenopausal women , the main reason to start hormone therapy ( HT ) is to reduce menopausal symptoms and to improve quality of life ( QOL ) . The aim of this study was to analyse the impact of HT on different aspects of symptom experience and QOL during a r and omised trial . A total of 1823 postmenopausal women were recruited into the Estonian Postmenopausal Hormone Therapy ( EPHT ) trial in 1999–2001 . Women were r and omised to blind HT , open-label HT , placebo or non-treatment arm . After one year in the trial , a question naire was mailed and 1359 women ( 75 % ) responded , 686 in the HT arms and 673 in the non-HT arms . Mean age at filling in the question naire was 59.8years . The question naire included Women 's Health Question naire ( WHQ ) to assess menopause specific QOL of middle-aged women together with a 17-item question naire on symptoms related to menopause , a question about painful intercourse , and a question about women 's self-rated health . Results After one year in the trial , fewer women in the HT arms reported hot flashes , trouble sleeping , and sweating on the symptom question naire . According to WHQ , women in the HT arms had fewer vasomotor symptoms , sleep problems , and problems with sexual behaviour , but more menstrual symptoms ;  HT had no effect on depression , somatic symptoms , memory , attractiveness , or anxiety . A smaller proportion of women reported painful intercourse in the HT arms . There were no significant differences between the trial arms in women ’s self-rated subjective health . Conclusions The results from the EPHT trial confirm that HT is not justified for treating symptoms , other than vasomotor symptoms , among postmenopausal women . WHQ proved to be a useful and sensitive tool to assess QOL in this age group of women OBJECTIVE To determine whether oophorectomy during the perimenopause , with the associated decline in ovarian and rogens , affects sexual function and psychological well-being negatively . DESIGN Prospect i ve , observational study comparing sexuality and psychological well-being in women after hysterectomy only ( HYST ) vs. hysterectomy and concomitant oophorectomy ( HYST+BSO ) .  SETTING University hospital and district general hospital . PATIENT(S ) Three hundred sixty-two perimenopausal women scheduled for elective hysterectomy on benign indication were recruited and 323 ( 89 % ) completed the 1-year follow-up ( 217 in the HYST group and 106 in the HYST+BSO group ) . INTERVENTION(S ) The patients were evaluated preoperatively and 1 year after surgery . Postoperatively , estrogen replacement therapy was recommended to all women in the HYST+BSO group and to HYST group subjects with climacteric symptoms . MAIN OUTCOME MEASURE(S ) Sex steroids ( T , and rostenedione , DHEA-S , and E(2 ) ) and sex hormone-binding globulin ( SHBG ) were measured . Free and rogen index and free E(2 ) index were calculated . Sexuality ( McCoy 's Female Sex Question naire ) and psychological well-being ( Psychological General Well-Being Index ) were evaluated . RESULTS ( S ) Preoperatively , no hormonal differences were found between the two groups . At 1-year follow-up , all sex steroid levels and indices were decreased and SHBG was increased in the HYST+BSO group . Ovarian sex steroids were decreased in the HYST group , whereas DHEA-S and SHBG were unaltered . Sexuality was unaltered in the HYST+BSO group , whereas decreased scores were found in 3 of 14 sexual variables in the HYST group . Psychological well-being was improved in both groups . There were no correlations between the observed changes ( data 1 year after surgery , compared with preoperative data ) in and rogen levels and index and the observed changes in any aspect of sexuality or psychological well-being . CONCLUSION ( S ) Hormonal changes after oophorectomy in conjunction with perimenopausal hysterectomy do not significantly change postoperative ( 1-year ) sexual or psychological well-being Background With the exception of sexual functioning and weight , social and behavioural effects of postmenopausal hormone therapy ( HT ) have not been reported from trials . This paper reports such results from the EPHT-trial in Estonia . Methods A r and omized trial , with a blind and non-blind sub-trial in Estonia . From 1999–2001 , 1778 women were recruited . The mean follow-up was 3.6 years . Women 's experiences were asked in the first and final study year by mailed question naires ( 74 and 81 % response rates ) . Comparisons of the groups were made by cross-tabulation and logistic regression , adjusting for age . Results There were no differences between the HT and non-HT groups in regard to being employed , the extent of social involvement or marital status or opinions on aging . There was no difference in the frequency of free-time exercise , or overweight . Some of the indicators suggested less sexual inactivity , but the differences were small . Conclusion In a trial setting , postmenopausal hormone therapy did not influence work or social involvement or health behaviour . Trial registration IS RCT BACKGROUND In perimenopause many women complain of psychogenic and organic disorders often connected with initial and increasing levels of hypoestrogenism . In this study we evaluated the effects of hormone replacement therapy ( HRT ) in symptomatic women in perimenopause . METHODS We enrolled 100 healthy and symptomatic women who were r and omly distributed to two groups for a 12-month study . Group A : 50 patients received HRT with estradiol valerate and cyproterone acetate ( Pausene(R ) ) ; Group B : 50 patients were used as a control group ( treated with Cacit Vitamin D30(R ) ) . A number of clinical and instrumental tests were performed at 0 , 6 and 12 months to evaluate any changes in vasomotor and urogenital symptoms , bone and serum homeostasis and possible sexual disorders . The statistical analysis was performed using the c2 test . RESULTS The group of women receiving HRT showed a significant reduction in vasomotor clinical symptoms ( p<0.001 ) and sexual disorders ( p<0.002 ) ; this was not reflected in the control group where libido decreased steadily with apparent slight improvements only at the end of the study . The urogenital disorders disappeared almost completely in Group A , whereas they diminished in Group B. HRT patients also showed a slight increase ( p<0.001 ) in the initial value of BMD ( bone mineral density ) , a reduction in the marker for bone turnover and an improved lipid profile ( p<0.05 ) . These changes were unfortunately not noted in Group B. CONCLUSIONS On the basis of these results we conclude that HRT appeared to have a beneficial effect on perimenopausal clinical symptoms over the 12-month period , leading to marked improvements in the psychophysical wellbeing of symptomatic women in perimenopause In this report we evaluated the action of conjugated equine estrogens ( CEE ) on vaginal symptoms , cytology , pH , and flora in late postmenopausal women without any previous hormone therapy . The study was a r and omized , double-blind , placebo-controlled trial with 48 late postmenopausal women who received placebo or unopposed CEE ( 0.625mg/day of CEE orally ) during three months of treatment .  Vaginal and sexual complaints were evaluated through daily diary cards . We analyzed vaginal changes through cytology and pH measurements . After three months of treatment , 20 % of placebo-treated patients and 80 % of the CEE-treated patients reported improvement in vaginal dryness and irritation . In the latter group , the vaginal cells and Lactobacillus increased and the vaginal pH decreased , without other changes in sexual complaints . We concluded that estrogen ameliorated the genital tract of late postmenopausal women without any previous hormone therapy Objective To assess the effects of raloxifene , estrogen , and placebo on quality of life in healthy , asymptomatic , postmenopausal women . Methods In a multicenter , double-blind , 12-month study , 398 women were assigned r and omly to one of four groups : raloxifene HCl , 60 ( n = 97 ) or 150 mg/day ( n = 100 ) ; conjugated equine estrogens , 0.625 mg/day ( n = 96 ) ; or placebo ( n = 105 ) . The Women 's Health Question naire , a vali date d quality -of-life instrument for perimenopausal and postmenopausal women , was administered at baseline and 3-month intervals . Results Overall , quality of life from baseline to end point was preserved equally in all treatment groups . Six domains ( depressed mood , somatic symptoms , memory/ concentration , sexual behavior , sleep problems , and perceived attractiveness ) were unchanged in all groups . Three domains ( menstrual symptoms , vasomotor symptoms , and anxiety/fears ) were statistically significantly different among groups . Mean scores for menstrual symptoms significantly worsened and vasomotor symptoms significantly improved from baseline to end point in the estrogen group . Mean scores for vasomotor symptoms did not worsen at any point in the raloxifene 60 mg/day group . Mean anxiety/fears scores improved significantly during raloxifene 60 mg/day administration throughout treatment ( P < .05 ) , irrespective of previous hormone replacement therapy , baseline estradiol ( E2 ) levels , or years postmenopause . Conclusion Most quality -of-life domains were not affected by treatment with estrogen or raloxifene . Estrogen provided relief from vasomotor symptoms but caused menstrual symptoms . Raloxifene 60 mg/day improved anxiety levels in postmenopausal women Background Adding testosterone to hormonal therapy could improve sexual function and general well-being among women during climacteric . We evaluated the effectiveness of testosterone undecanoate on sexual function in postmenopausal women utilizing the st and ardized question naire FSFI score . Methods Postmenopausal women with sexual complaints and Female Sexual Function Index ( FSFI ) ≤ 26.5 were enrolled in to this r and omized , double-blinded , placebo-controlled trial . Participants were r and omly assigned to 8-week treatment with either oral testosterone undecanoate 40 mg or placebo twice weekly with daily oral estrogen .  The FSFI scores before and after treatment were compared to assess any improvement of sexual function . Results Seventy women were recruited of which each group had 35 participants . The baseline characteristics and baseline FSFI scores were comparable between both groups . After 8 weeks of treatment , the FSFI scores significantly improved in both groups when compared to the baseline but the FSFI scores from the testosterone group were significantly higher than in the placebo group post-treatment ( 28.6 ± 3.6 , 25.3 ± 6.7 , respectively , p = 0.04 ) . There was no difference in adverse effect between the two groups Conclusions The twice weekly addition of testosterone undecanoate to daily oral estrogen was associated with a significant improvement in sexual function  among postmenopausal women than the use of the estrogen alone . Trial registration Clinical Trials.gov Identifier NCT01724658 ( February 17 , 2012 ) From a longitudinal prospect i ve study , 160 women with spontaneous menopause and without steroid medication were followed during the transition from pre- to  postmenopause  . After 12 years 152 women were still participating in the study . Blood sample s were drawn every 6 months until 1 year after the menopause and every 12 months thereafter . Measurements of bone mineral density ( BMD ) on the forearm were performed every second year . All women routinely completed a question naire concerning symptoms frequently attributed to the climacteric period . All data were grouped around the onset of the menopause , thereby allowing longitudinal evaluation of the changes in the variables from the premenopausal to the postmenopausal period . The beginning of the perimenopausal period was characterized by transitory elevations of follicle-stimulating hormone ( FSH ) . A significant increase in serum levels of gonadotropins was observed for both FSH and luteinizing hormone ( LH ) from about 5 years before the menopause . Within the 6 month period around the menopause there was a further increase which culminated within the first postmenopausal year for LH and 2 - 3 years postmenopause for FSH . Thereafter , a continuous decrease in LH occurred over the following 8 years . With respect to FSH , there was a slight decline starting about 4 years postmenopause . During the premenopausal period an increasing frequency of inadequate luteal function or anovulation occurred and , in the postmenopausal years , the serum levels of progesterone ( P ) were invariably low . Gradually , the ratio between estrone ( E1 ) and 17-beta-estradiol ( E2 ) increased , reflecting the declining follicular steroidogenesis . A marked decrease in estrogen levels occurred during the 6 month period around the menopause , most pronounced in E2 . During the next 3 years , the levels of E2 and E1 showed an essentially parallel , moderate decline . Around the menopause , serum levels of testosterone ( T ) , delta 4- and rostenedione ( A ) and sex hormone-binding globulin ( SHBG ) showed small but significant decreases . From about 3 years postmenopause , the levels were relatively constant over the following 5 years . A decrease in BMD was observed in the postmenopause , and from about 3 years postmenopause , estradiol correlated positively with BMD . Before , as well as after the menopause , body mass index ( BMI ) showed an inverse correlation with SHBG . Postmenopausal and rostenedione correlated positively with E1 , E2 and T. BMI correlated positively with E1 and E2 . The concentrations of the free fraction of E2 and T are dependent on the levels of SHBG , which in turn has a negative correlation with BMI . The impact of this will influence the severity of symptoms , the degree of bone loss and the need for supplementary therapy Objective To compare the effect of different formulations of continuous combined hormone therapy on sexual performance in naturally postmenopausal women . Material and methods A total of 158 postmenopausal women were enrolled and prospect ively r and omized to the single-blind study . Fifty-four women received tibolone 2.5 mg , 53 received 2 mg estradiol and 2 mg dienogest ( E2/dienogest ) , and 51 did not receive any menopausal therapy . The patients were monitored after 6 months . Attitudes of sexuality were evaluated by using the Rosen 's female sexual function index . Results Compared with E2/dienogest and the control group , tibolone treatment was associated with more improvement of sexual performance , including sexual desire , sexual arousal and satisfaction . Both of the hormone therapies decreased frequencies of vaginal dryness and painful intercourse . Conclusions Tibolone has more positive effects on the sexual dysfunction of postmenopausal women and may be an alternative to the E2/dienogest preparation in postmenopausal women with sexual dysfunction Objective : To determine the difference , if any , in the placebo response when both perimenopausal and postmenopausal women are enrolled , compared with postmenopausal women alone , in a study assessing the efficacy of synthetic conjugated estrogen tablets on moderate-to-severe vasomotor symptoms ( MSVS ) . Methods : A total of 120 healthy women ( 72 active ; 48 placebo ) complaining of moderate-to-severe vasomotor symptoms were enrolled in a r and omized , placebo-controlled , double-blind , multicenter clinical trial . In all , 109 patients completed treatment to week 12 . Women were enrolled using minimal inclusion and exclusion criteria , and included perimenopausal women ( n = 34 ; 0 to 6 months since last menses ) as well as menopausal women ( n = 79 ; > 12 months since last menses ) . Results : Changes in MSVS in the intent-to-treat ( ITT ) population showed differences between the active and placebo treatments at weeks 4 ( p < 0.022 ) , 8 ( p < 0.010 ) and 12 ( p < 0.010 ) . At week 12 , the mean percentage reduction in MSVS was 81 % for the active treatment group and 58 % in the placebo treatment group . To examine the placebo response , the ITT population was broken down into groups defined by the time since their last menses . The perimenopausal group ( 0 to 6 months since last menses ) demonstrated a consistently higher placebo response than that of the postmenopausal groups ( > 12 months since last menses ) . Conclusions : Perimenopausal women contributed to a higher placebo response , compared with the rate of response previously reported in clinical studies of estrogen replacement in postmenopausal women . Including perimenopausal women in future vasomotor symptom trials will require study population s of sufficient size to maintain the statistical power to demonstrate a difference between therapeutic response to active or placebo treatment Background Awareness of the risks associated with hormone therapy for menopausal symptoms has sparked a global decline in this treatment . Alternative treatments to relieve menopausal symptoms are therefore required . The applied relaxation ( AR ) technique has proven to be successful for symptom amelioration , but requires participation in 12 weekly classes . The purpose of this study was to determine the effectiveness of a modified relaxation version ( MR ) of AR for treatment of hot flashes , night sweats , and sleep disturbances . Methods We conducted a12-week , r and omized , parallel , open-label , controlled trial in perimenopausal and postmenopausal women visiting the menopausal clinic . Participants were r and omly assigned to an MR or AR group . The MR group ( n=36 ) received a single session of ( MR ) training and the AR group ( n=35 ) received conventional 12-week training . Participants were instructed to practice the techniques daily at home for 12 weeks . The main outcome was the measure on the severity scale and frequency of hot flashes , night sweats , and sleep disturbances . Results All participants completed the study .  Total severity scores in both groups decreased after 12 weeks , but there was no difference between the groups ( P=0.93 ) . The severity score for hot flashes in the MR group decreased more than in the AR group ( P=0.02 ) . The severity scores for night sweats and sleep disturbances decreased in both groups . The frequency of hot flashes , night sweats , and sleep disturbances were also decreased in both groups . Conclusion A shorter , modified version of the AR was equally effective or slightly better than the conventional AR for the relief of hot flashes , night sweats , and sleep disturbances in perimenopausal and postmenopausal women . Recommendations for future research include confirmatory studies and trials with larger sample OBJECTIVE To evaluate the benefits and risks of hormone replacement therapy ( HRT ) combined with methyltestosterone ( MT ) in postmenopausal women with sexual dysfunction .  DESIGN This study was a r and omized , double-blind , placebo-controlled and crossover trial . Eighty-five women using HRT  were divided into four treatment groups : GI-HRT plus placebo for 4 months ; GII-HRT plus MT 2.5mg/day for 4 months ; GIII-HRT plus placebo for 2 months and then replaced with HRT plus MT 2.5mg/day for 2 months ; GIV-HRT plus MT 2.5mg/day and then replaced with HRT plus placebo for 2 months . Blood was collected at baseline , after 2 months ( T1 ) and 4 months ( T2 ) of treatment for hormone determinations of estradiol , FSH , total and free testosterone , GOT , GPT , glucose , total and fractions of cholesterol and triglycerides . All participants answered clinical questions and a vali date d question naire of modified McCoy 's sex scale . RESULTS The association of HRT with MT 2.5mg/day did not significantly change liver enzymes or increase cardiovascular risk factors . The patients of GII , GIIII and GIV when using MT presented amelioration of sex symptoms , mainly satisfaction and desire ( p<0.01 ) ; however , GIII at T1 ( 1.3+/-0.3 ) presented similar problem score results as compared to GIII at T2 ( 1.5+/-0.6 ) . CONCLUSION All data suggest that combined HRT- and rogen therapy may be beneficial for postmenopausal women receiving HRT who continue to complain of sexual difficulties or for postmenopausal women with sexual complaints who are not undergoing estrogen therapy We conducted a double-blind , placebo-controlled study to determine the role of dietary supplementation on sexual function in women of differing menopausal status . One hundred eight ( 108 ) women , age 22–73 years , who reported a lack of sexual desire , enrolled as participants . Of these , 55 received ArginMax for women and 53 received placebo . ArginMax for women contains L-arginine , ginseng , ginkgo , damiana , multivitamins , and minerals . The 108 women , given definitions , self-reported as 59 premenopausal ( PRE ) ; 20 perimenopausal ( PERI ) , and 29 postmenopausal ( POST ) . After 4 weeks , PRE women on ArginMax primarily reported significant improvement in level of sexual desire ( 72 % ; p = 0.03 ) and satisfaction with overall sex life ( 68 % ; p = 0.007 ) , compared with placebo group , according to the Female Sexual Function Index ( FSFI ; Kaplan et al. , 1999 ) scales . Frequency of sexual desire ( 60 % ; p = 0.05 ) and frequency of intercourse ( 56 % p = 0.01 ) also increased among the PRE women . In contrast , among PERI women , primary improvements were reported for frequency of intercourse ( 86 % ; p = 0.002 ) , satisfaction with sexual relationship ( 79 % ; p = 0.03 ) , and vaginal dryness ( 64 % ; p = 0.03 ) compared with placebo group . POST women primarily showed an increased in level of sexual desire , with 51 % showing improvement , compared with only 8 % in the placebo group ( p = 0.008 ) . Nutritional intervention plays an important role in women 's sexual health , but issues and areas of greatest improvement differ among women of different menopausal states . The largest number of attribute improvements were seen in PRE and PERI women , although attribute types vary among these groups . Level of desire was shown to increase significantly in POST women . Since ArginMax for women has been shown to exhibit no estrogen activity , it may be desirable alternative to hormone therapy for sexual concerns Objective To evaluate the effect of the addition of methyltestosterone to estrogen and progestogen therapy on postmenopausal sexual energy and orgasm . Methods Sixty postmenopausal women in a stable relationship with a partner capable of intercourse , and presenting sexual complaints that appeared after menopause , were r and omly divided into two groups : EP ( n = 29 ) received one tablet of equine estrogens ( CEE ) 0.625 mg plus medroxyprogesterone acetate ( MPA ) 2.5 mg and one capsule of placebo ; EP + A ( n = 31 ) received one tablet of CEE 0.625 mg plus MPA 2.5 mg and one capsule of methyltestosterone 2.0 mg ; The treatment period was 12 months . The effects of treatment on sexual energy were assessed using the Sexual Energy Change Scale . The ability to reach orgasm in sexual relations with the partner was verified through monthly calendars and by calculating the ratio between monthly frequency of orgasms in sexual relations and monthly sexual frequency . Results There was a significant relationship between improvement in level of sexual energy and the addition of methyltestosterone to CEE/MPA treatment ( p = 0.021 ) . No significant effect on orgasmic capacity was noted after the treatment period . Conclusion Addition of methyltestosterone to CEE/MPA therapy may increase sexual energy , but might not affect the ability to obtain orgasm in sexual relations OBJECTIVE The aim of this study was to screen for disorders and to histologically classify endometrial biopsy specimens from 2964 perimenopausal and postmenopausal women who were c and i date s for hormonal replacement therapy .  STUDY DESIGN Endometrial biopsy specimens were obtained with a Vabra aspiration curette , processed by st and ard methods , and stained by hematoxylin and eosin and special methods to reveal subtle features of the endometrium . RESULTS Of the endometrial biopsy specimens , 68.7 % were atrophic , 23.5 % were proliferative , 0.5 % were secretory , 0.6 % were hyperplastic , 0.07 % were adenocarcinoma , and 6.6 % were insufficient for classification . Three independent senior microscopists agreed on the classification of each biopsy specimen . CONCLUSION The number of patients is the largest ever screened for a single hormone replacement therapy study . The low yield of endometrial cancer indicates that biopsies are unnecessary before hormone replacement therapy is initiated in asymptomatic women OBJECTIVE To investigate the efficacy of esterified estrogens alone and combined with oral and rogen on sexual function and menopausal symptoms in postmenopausal women . STUDY DESIGN Twenty postmenopausal women dissatisfied with their estrogen or estrogen-progestin therapy volunteered to enter a double-blind , r and omized trial in which they received either oral esterified estrogens or esterified estrogens + and rogen for eight weeks after a single-blind , placebo , lead-in period . Sexual function was assessed with a question naire used in the Yale midlife survey , and plasma levels of estradiol , estrone , sex hormone binding globulin ( SHBG ) and beta-endorphin were measured at two- to four-week intervals . RESULTS Estrogen- and rogen therapy significantly improved sexual sensation and desire after four and eight weeks of double-blind treatment in comparison to previous estrogen therapy and postplacebo baseline assessment s. Plasma levels of estradiol and estrone increased significantly in all patients as compared to the postplacebo baseline and decreased in comparison to circulating estrogen concentrations on previous therapy . Relative proportions of free and bound steroid hormone exhibited contrasting shifts during estrogen and estrogen- and rogen therapy .  SHBG increased in the estrogen group and decreased in the estrogen- and rogen group , leading to lower amounts of free and rogens during estrogen therapy and increased free and rogen levels during estrogen- and rogen therapy . Since proportions of free ( bioavailable ) ovarian steroids would correlate inversely with plasma protein binding capacity , the beneficial effects of oral estrogen- and rogen therapy on sexual sensation and desire may be due either to the administered and rogen or to the increased availability of endogenous and exogenous and rogens , particularly in the central nervous system . CONCLUSION Sexual desire , satisfaction and frequency in postmenopausal women taking hormonal therapy were improved significantly by combined estrogen- and rogen therapy but not by estrogen or estrogen-progestin therapy .  Sexual function improved with estrogen- and rogen therapy even though circulating estrogen levels were lower than those measured during previous estrogen therapy . This leads to the conclusion that and rogens play a pivotal role in sexual function but that estrogens are not a significant factor determining levels of sexual drive and enjoyment Summary In this prospect i ve study in 2,137 perimenopausal and early postmenopausal women who were followed over a 13.1-year period of time , we observed no association between bone mineral density measured at the beginning of menopause and the subsequent risk of breast cancer . Introduction This study aim ed to investigate the relationship between BMD and the risk of breast cancer ( BC ) in young postmenopausal women . Methods As part of a clinical research program , 2,137 women who were perimenopausal or within their 5 first postmenopausal years were scanned  between 1988–1990 and review ed on average 13.1 years after their initial examination . Ninety-eight incident BC cases were recorded throughout the follow-up . Results Women with incident BC significantly differed from those who had never had BC with regard to age at menarche , age of birth of 1st child , familial history of BC and postmenopausal hormone therapy ( PHT ) use . There was no significant difference between the two groups for baseline DXA of the spine . There was a trend for BC cases for having lower femoral neck BMD compared to women without BC . However , women with low BMD were more likely to have taken PHT by the end of the study . In Cox multivariate analyses the relationship between BC risk and femoral neck BMD no longer existed . Conclusions There was no relationship between BMD measured within the first postmenopausal years and the risk of BC , which makes unlikely the possibility of using BMD as a predictor factor for BC in early postmenopausal women
HT treatment with estrogens alone or in combination with progestogens was associated with a small to moderate improvement in sexual function , particularly in pain , when used in women with menopausal symptoms or in early postmenopause ( within five years of amenorrhoea ) , but not in unselected postmenopausal women .
The current evidence does not suggest an important effect of tibolone or of SERMs alone or combined with estrogens on sexual function .
BACKGROUND The perimenopausal and postmenopausal periods are associated with many symptoms , including sexual complaints .
OBJECTIVES To assess the effect of hormone therapy ( HT ) on  sexual function in perimenopausal and postmenopausal women .