Sex and the estrogen patch

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In the pill-versus-patch debate over estrogen for menopausal women, the patch may have an edge in an important area: sexual function. In a recent Yale trial, women who received estrogen replacement via a sticker on the skin reported better sexual function than those who took a pill.

“What this study does is help to refine how we use hormones after menopause—to personalize it a bit more,” says Hugh Taylor ’83, the principal investigator for the study; he chairs the obstetrics, gynecology, and reproductive sciences department at the medical school.

On top of hot flashes and night sweats, menopause can herald low libido, vaginal atrophy, pain during intercourse, and other sexual problems. Though doctors knew estrogen replacement could help improve sexual function for women in early menopause, they didn’t know which delivery method was better.

As part of a larger study of hormone replacement, researchers randomly assigned 670 women early in menopause to receive an oral equine-estrogen pill, a transdermal estradiol patch, or a placebo. About three-quarters of them had low sexual function when the study began. The study lasted four years, and every 18 months, the participants answered a questionnaire about their sexual function and satisfaction. Both oral and patch estrogen helped more than the placebo, but women on the patch scored better on the questionnaire and reported less pain. The study appeared online in JAMA Internal Medicine.

But don’t get too excited. The improvement was small: the patch scored 7.2 percent higher than the placebo, the pill just 3.9 percent higher. And scores for both diminished over time.

The effect “was modest enough that it should not be the primary driver of whether you use hormones, or which hormone preparation to use,” Taylor cautions. “However, the effect was greater in those with preexisting sexual dysfunction, and those people probably should favor a patch—all other things being equal.”