title: Hormonal and psycho-relational aspects of sexual function during menopausal transition and at early menopause.
abstract: OBJECTIVE
  The aim of the present observational, cross-sectional study was to examine the effects of hormonal and psycho-relational variables on sexual function during menopausal transition and at early postmenopause in women with hot flushes.
  
  
  METHODS
  The sample comprised 138 women referred to a clinic for the treatment of hot flushes. They were categorised according to their stage of menopausal transition using the STRAW criteria: early menopausal transition (EMT) if their menstrual cycle was 7 or more days different from normal; late perimenopause (LMT) if they had experienced 60 days or more of amenorrhoea; and early postmenopause (EPM) if their amenorrhoea had lasted for at least 12 months but less than 4 years.
  
  
  METHODS
  Sexual function was measured by using the Female Sexual Function Index (FSFI), while anxiety (state and trait), depression, eating disorder and marital adjustment were evaluated by validated self-report questionnaires. Levels of free testosterone (FT), dehydroepiandrosterone sulfate (DHEAS) and estradiol (E2) were also measured.
  
  
  RESULTS
  Overall sexual function varied significantly with stage of menopause, with total FSFI score less in EPM than in EMT (p=.009). A similar pattern was evident on FSFI sub-scales for sexual desire (p=.02), arousal (p=.01) orgasm (p=.01) and also pain (p=.02), but not for lubrication and satisfaction. Ratings for anxiety, depression and eating disorder did not differ across the menopausal sub-groups, and neither did ratings of marital adjustment. Both FT (p=.01) and DHEAS (p=.03) levels were slightly reduced at EPM in comparison with EMT, as were E2 levels (p=.001 EMT versus LMT; p=.0001 LMT versus EPM). In multiple regression analyses, plasma FT level was the only factor to predict FSFI full score (beta=.48; p=0.004) in women at EMT, while in women at LMT the depression score was the only factor to do so (beta=-.62; p=0.0001). The best model predicting FSFI full score at EPM included levels of DHEAS and E2 levels and state anxiety score.
  
  
  CONCLUSIONS
  Hormonal and some psychological variables are relevant to sexual function in symptomatic women during menopausal transition and at early menopause but their role differs with the specific stage of reproductive ageing.
authors.affiliation: Research Center for Reproductive Medicine, Dept of Morphological, Eidological & Clinical Sciences, University of Pavia, Pavia, Italy. renappi@tin.it
authors.forename: Rossella E
authors.initials: RE
authors.lastname: Nappi
authors.forename: Francesca
authors.initials: F
authors.lastname: Albani
authors.forename: Valentina
authors.initials: V
authors.lastname: Santamaria
authors.forename: Silvia
authors.initials: S
authors.lastname: Tonani
authors.forename: Flavia
authors.initials: F
authors.lastname: Magri
authors.forename: Ellis
authors.initials: E
authors.lastname: Martini
authors.forename: Luca
authors.initials: L
authors.lastname: Chiovato
authors.forename: Franco
authors.initials: F
authors.lastname: Polatti
mesh_terms: D001007:Anxiety / Q000150:complications; D003430:Cross-Sectional Studies; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D003863:Depression / Q000150:complications; D004958:Estradiol / Q000097:blood; D005260:Female; D006306:Health Surveys; D019584:Hot Flashes; D006801:Humans; D008593:Menopause / Q000502:physiology / Q000523:psychology; D008875:Middle Aged; D012044:Regression Analysis; D012735:Sexual Dysfunction, Physiological / Q000097:blood; D020018:Sexual Dysfunctions, Psychological / Q000097:blood; D011795:Surveys and Questionnaires; D013739:Testosterone / Q000097:blood
chemical_list: D013739:Testosterone; D004958:Estradiol; D019314:Dehydroepiandrosterone Sulfate