Health  Vol.8 No.9 , June 2016
Beneficial Effects of Tibolone on Sexual Dys-function in Women with Premature Ovarian Failure (POF)
Abstract: Introduction: Premature Ovarian Failure (POF) is cessation of ovarian functions before the age of 40 years old with consequent cessation of menstruation. Objective of study: The aim of this study was to evaluate the association between Premature Ovarian Failure and sexual dysfunctions and outcome of management with tibolone. Patients and Methods: Thirty-one women with Premature Ovarian Failure seen at the outpatient clinic of Maternity Hospital were enrolled into the study with 31 healthy women as control group. The instrument of data collection included two types of questionnaires to assess the effect of Premature Ovarian Failure on sexuality. All the women with POF had oral tibolone 2.5 mg for at least one year and the second questionnaire and the profiles were repeated. Results: Of the 31 women with POF that presented with sexual dysfunction (SD), 27 (87.1%) complained of one or more SD domains such as reduced frequency of coitus, dyspareunia, vaginal dryness, reduced libido and general sexual satisfaction (P < 0.01), amenorrhea (P < 0.01) and hot flashes compared to 5 (16.1%) control women (P < 0.01). Administration of tibolone was associated with significant increase in frequency of coitus, reduced dyspareunia and vaginal dryness, increase libido and general satisfaction and happiness. Reduction of sexual dysfunction was predicated on the estrogenic, progestogenic and androgenic metabolite of tibolone through the reduction of serum level of FSH and LH and increased levels of estrogen and testosterone (P < 0.01). Tibolone had no adverse effect on serum lipid profile. Conclusion: Premature Ovarian Failure is associated with sexual dysfunction. Tibolone provides an effective means of treating sexual dysfunction caused by Premature Ovarian Failure.
Cite this paper: Omu, F. , Elbiaa, A. , Ghafour, A. , Gadalla, I. and Omu, A. (2016) Beneficial Effects of Tibolone on Sexual Dys-function in Women with Premature Ovarian Failure (POF). Health, 8, 857-867. doi: 10.4236/health.2016.89090.

[1]   Pacello, P.C., Yela, D.A., Rabelo, S., Giraldo, P.C. and Benetti-Pinto, C.L. (2014) Dyspareunia and Lubrication in Premature Ovarian Failure Using Hormonal Therapy and Vaginal Health. Climacteric, 17, 342-347.

[2]   Shuster, L.T., Rhodes, D.J., Gostout, B.S., Grossardt, B.R. and Rocca, W.A. (2010) Premature Menopause or Early Menopause: Long-Term Health Consequences. Maturitas, 65, 161-166.

[3]   Graziottin, A. and Leiblum, S.R. (2005) Biological and Psychosocial Pathophysiology of Female Sexual Dysfunction during the Menopausal Transition. The Journal of Sexual Medicine, 2, 133-145.

[4]   Omu, A.E. and AlQattan, N. (1997) Effects of Hormone Replacement Therapy on Sexuality in Postmenopausal Women in a Mideast Country. Journal of Obstetrics and Gynaecology Research, 23, 157-164.

[5]   Graziottin, A. and Basson, R. (2004) Sexual Dysfunction in Women with Premature Menopause. Menopause, 11, 766-777.

[6]   de Almeida, D.M., Benetti-Pinto, C.L. and Makuch, M.Y. (2011) Sexual Function of Women with Premature Ovarian Failure. Menopause, 18, 262-266.

[7]   Dennerstein, L., Koochaki, P.E., Barton, I. and Graziottin, A. (2006) Hypoactive Sexual Desire Disorder in Menopausal Women: A Survey of Western European Women. The Journal of Sexual Medicine, 3, 212-222.

[8]   Kalantaridou, S.N., Calis, K.A., Vanderhoof, V.H., et al. (2006) Testosterone Deficiency in Young Women with 46, XX Spontaneous Premature Ovarian Failure. Fertility and Sterility, 86, 1475-1482.

[9]   Basson, R. (2000) The Female Sexual Response: A Different Model. Journal of Sex and Marital Therapy, 26, 51-65.

[10]   Bancroft, J., Loftus, J. and Long, J.S. (2003) Distress about Sex: A National Survey of Women in Hetersexual Relationships. Archives of Sexual Behavior, 32, 193-208.

[11]   Artune-Ulkumen, B., Erkan, M.M., Pala, H.G. and Bulbul Baytur, Y. (2014) Sexual Dysfunction in Turkish Women with Dyspareunia and Its Impact on the Quality of Life. Clinical and Experi-mental Obstetrics and Gynecology, 41, 567-571.

[12]   Zhang, H., Fan, S. and Yip, P.S. (2015) Sexual Dysfunction among Reproductive-Aged Chinese Married Women in Hong Kong: Prevalence, Risk Factors, and Associated Consequences of Ovarian Failure. The Journal of Sexual Medicine, 12, 738-745.

[13]   Vodusek, D.B. (2013) Sexual Dysfunction in Patients with Peripheral Nervous Disorders. Autonomic Neuroscience: Basic and Clinical, 177, 20.

[14]   Benetti-Pinto, C.L., Soares, P.M., Giraldo, H.P.D. and Yela, D.A. (2015) Role of the Different Sexuality Domains on the Sexual Function of Women with Premature Ovarian Failure. The Journal of Sexual Medicine, 12, 685-689.

[15]   Garefalakis, M. and Hickey, M. (2008) Role of Androgens, Progetins and Tibolone in the Treatment of Menopausal Symptoms: A Review of the Clinical Evidence. Clinical Interventions in Aging, 3, 1-8.

[16]   Drillich, A. and Davis, S.R. (2007) Androgen Therapy in Women: What We Think We Know. Experimental Gerontology, 42, 457-462.

[17]   Ziaei, S., Moghasemi, M. and Faghihzadeh, S. (2010) Comparative Effects of Conventional Hormone Replacement Therapy and Tibolone on Climacteric Symptoms and Sexual Dysfunction in Postmenopausal Women. Climacteric, 13, 147-156.

[18]   Modelska, K. and Cummings, S. (2002) Tibolone for Post-Menopausal Women: Systematic Review of Randomized Trials. The Journal of Clinical Endocrinology and Metabolism, 87, 16-23.

[19]   Lamarca, M. (2012) The Role of Hormone Replacement Therapy (HRT) and Tibolone in the Prevention and Treatment of Postmenopausal Osteoporosis. In: Dionyssiotis, Y., Ed., Osteoporosis, InTech, Chapter 29.

[20]   Formoso, G., Perrone, E., Maltoni, S., Balduzzi, S., D’Amico, R., Bassi, C., Basevi, V., Marata, A.M., Magrini, N. and Maestri, E. (2012) Short and Long Term Effects of Ti-bolone in Postmenopausal Women (Review). The Cochrane Collaboration, Cochrane Database of Systematic Reviews, 15, Article ID: CD008536.

[21]   Egarter, C., Sator, M., Berghammer, P. and Huber, J. (1999) Efficacy, Tolerability and Rare Side-Effects of Tibolone Treatment of Postmenopausal Women. International Journal of Gynecology & Obstetrics, 64, 281-286.

[22]   Derogatis, L.R. (2008) Assessment of Sexual Func-tion/Dysfunction via Patient Reported outcomes. International Journal of Impotence Research, 20, 35-44.

[23]   Rosen, R., Brown, C., Heiman, J., Leiblum, S., Meston, C., Shabsigh, R., Ferguson, D. and D’Agostino, R. (2000) The Female Sexual Function Index (FSFI): A Multidimensional Self-ReportInstrument for the Assessment of Female Sexual Function. Journal of Sex and Marital Therapy, 26, 191-208.

[24]   Roudsari, R.L., Javadnoori, M., Hasanpour, M., Hazavehei, S.M.M. and Taghipour, A. (2013) Socio-Cultural Challenges to Sexual Health Education for Female Adolescents in Iran. Iranian Journal of Reproductive Medicine, 11, 101-110.

[25]   Ebrahim, M. and Asbagh, F.A. (2011) Pathogenesis and Causes of Premature Ovarian Failure: An Update. International Journal of Fertility & Sterility, 5, 54-65.

[26]   Omu, A.E. and Al-Qattan, N. (1996) Premature Menopause. Singapore Journal of Obstetrics and Gynaecology, 27, 23-28

[27]   Nappi, R.E. and Lachowky, M. (2009) Menopause and Sexuality: Prevalence of Symptoms and Impact on Quality of Life. Maturitas, 63, 138-141.

[28]   Kloosterboer, H.J. (2004) Tissue-Selectivity: The Mechanism of Action of Tibolone. Maturitas, 48, 30-40

[29]   Kloosterboer, H.J. (2001) Tibolone: A Steroid with Tissue Specific Mode of Action. The Journal of Steroid Biochemistry and Molecular Biology, 76, 231-238.

[30]   Cummings, S.R., Ettinger, B., Delmas, P.D., Kenemans, P., Stathopoulos, V., Verweij, P. and LIFT Trial Investigators. (2008) The Effects of Tibolone in Older Postmenopausal Women. The New England Journal of Medicine, 359, 697- 708.

[31]   van der Stege, J.G., Groen, H., van Zadelhoff, S.J., Lambalk, C.B., Braat, D.D., van Kasteren, Y.M., et al. (2008) Decreased Androgen Concentrations and Diminished General and Sexual Well-Being in Women with Premature Ovarian Failure. Menopause, 15, 23-31.

[32]   Deeks, A. (2002) Sexual Desire: Menopause and Its Psychological Impact. Australian Family Physician, 31, 433-439.

[33]   Singer, D., Mann, E., Hunter, M.S., Pitkin, J. and Panay, N. (2011) The Silent Grief: Psychosocial Aspects of Premature Ovarian Failure. Climacteric, 14, 428-437.

[34]   Okeke, T.C., Anyaehie, U.B. and Ezenyeaku, C.C. (2013) Premature Menopause. Annals of Medical and Health Sciences Research, 3, 90-95.

[35]   ESHRE (2015) Management of Women with Premature Ovarian Insufficiency. Guideline of the European Society of Human Reproduction and Embryology. POI Guideline Development Group.