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

UMMS Affiliation

UMass Worcester Prevention Research Center; Department of Medicine, Division of Preventive and Behavioral Medicine

Publication Date


Document Type



Behavioral Medicine | Behavior and Behavior Mechanisms | Community Health | Community Health and Preventive Medicine | Hormones, Hormone Substitutes, and Hormone Antagonists | Preventive Medicine | Public Health | Women's Health


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.


Genitourinary syndrome of menopause, Hormone therapy discontinuation, Sexual function

DOI of Published Version



Menopause. 2018 Mar;25(3):252-264. doi: 10.1097/GME.0000000000000994. Link to article on publisher's site

Journal/Book/Conference Title

Menopause (New York, N.Y.)

Related Resources

Link to Article in PubMed

PubMed ID