Cerrahi Menopozda Oral ve Transdermal Östrojen Tedavilerinin Hastaların Psikolojik Durumları ve Cinsel Fonksiyonları Üzerine Etkisi

Yıl 2018, Cilt: 44 Sayı: 3, 153 - 158, 01.12.2018

Fatih Yılmaz , Alparslan Baksu

https://doi.org/10.32708/uutfd.425479

Öz

Cerrahi
menopozun hastaların psikolojik durum ve cinsel fonksiyonlara etkisi ve
tedavisi halen tartışmalıdır. Bu amaçla transabdominal histerektomi ve
bilateral salpingooferektomi (TAH+BSO) geçiren hastalarda oral ve transdermal
östrojen tedavilerinin psikolojik durumlar ve cinsel fonksiyonlar üzerine
etkilerini karşılaştırdık. Çalışmamızda benign endikasyonlarla TAH+BSO yapılan
52 hasta rastgele randomizasyonla üç gruba ayrıldı. Ameliyattan 12 hafta sonra 18
hastaya oral östrojen (grup 1), 17 hastaya transdermal östrojen (grup 2)
başlandı. 17 hastadan oluşan kontrol grubuna (grup 3) tedavi verilmedi. Hastalara
ameliyattan önce, 12 ve 28 hafta sonra Beck Depresyon İndeksi (BDI) ve Kadın Cinsel
Fonksiyon İndeksi (FSFI) uygulandı. Oral grupta tedavi sonrası psikolojik
durumlar ve cinsel fonksiyonlar üzerine olumlu yanıt gözlenirken transdermal
grupta değişiklik gözlenmedi. Kontrol grubunda ameliyat öncesi ve sonrası
arasında değişiklik olmadı.  Bu
sonuçlarla çalışmamızda cerrahi menopozun hastaların psikolojik durum ve cinsel
fonksiyonları üzerine değişiklik görülmezken oral östrojen tedavisinin olumlu
etkileri görülmüştür. 

Anahtar Kelimeler

Anahtar Kelimeler: Cerrahi menopoz, Psikolojik durum, Cinsel fonksiyon, Östrojen etkisi

The Effect of Oral and Transdermal Estrogen Therapy on the Psychological Situations and Sexual Functions of Patients in Surgical Menopause

Öz

The effect and treatment of
psychopathological conditions and sexual functions of surgically menopausal
patients is still controversial. For this purpose, we compared the effects of
oral and transdermal estrogen treatments on psychological status and sexual
function in patients who underwent transabdominal hysterectomy and bilateral salpingo-oophorectomy
(TAH + BSO). In our study, 52 patients who underwent TAH + BSO with benign
indications were randomly assigned to three groups. Twelve weeks after the
operation, 17 patients were not treated as a control group (group 1), 18
patients were given oral estrogen (group 2) and 17 patients were transdermal
estrogen (group 3). Beck Depression
Index (BDI) and Female Sexual Function Index (FSFI) were administered before
operation, 12 and 28 weeks after operation. There was no change in
preoperative and postoperative results in group 1. In group 2, there was a
positive response to psychological conditions and sexual functions after
treatment, but no change in group 3 was observed. As a result of our study, it was observed that positive effects of oral
estrogen therapy could be seen when there was no effect on the psychological
status and sexual functions of surgical menopausal patients.

Anahtar Kelimeler

Surgical menopause, Psychological condition, Sexual function, Estrogen replacement terapy

Kaynakça

• KAYNAKLAR
• 1. Rodriguez M, Shoupe D. Surgical menopause. Endocrinol Metab Clin North Am. 2015 Sep;44(3):531-42.
• 2. Taylor HS, Tal A, Pal L et al. Effects of oral vs transdermal estrogen therapy on sexual function in early postmenopause: ancillary study of the Kronos early estrogen prevention study (KEEPS). JAMA Intern Med. 2017 Oct 1;177(10):1471-1479.
• 3. Kokcu A, Kurtoglu E, Bildircin D ve ark. Does surgical menopause affect sexual performance differently from natural menopause? J Sex Med. 2015 Jun;12(6):1407-14.
• 4. Caruso S, Rapisarda AM, Cianci S. Sexuality in menopausal women. Curr Opin Psychiatry. 2016 Nov;29(6):323-30.
• 5. Nappi RE, Cucinella L, Martella S et al. Female sexual dysfunction (FSD): Prevalence and impact on quality of life (QoL). Maturitas. 2016 Dec;94: 87-91.
• 6. Açmaz G, Albayrak E, Aksoy H ve ark. Cerrahi menopozlu hastaların depresyon anksiyete ve uyku kalitesi sıklığı açısından araştırılması. Bozok Tıp Derg 2014;4(1):22-28.
• 7. Sözeri-Varma G, Kalkan-Oğuzhanoğlu N, Karadağ F, Özdel O, Amuk T. Doğal ve cerrahi menopozda depresyon ve anksiyete düzeyleri ile cinsel doyum arasındaki ilişki. Klinik Psikiyatri 2005; 8: 109-115.
• 8. Karlıdere T, Özşahin A. The relationship of menopausal symptomatology with anxiety and depression levels and social supports. J Clin Psy. 2008; 11(4): 159-166.
• 9. Cabral PU, Canário AC, Spyrides MH, et al. Determinants of sexual dysfunction among middle-aged women. Int J Gynaecol Obstet. 2013 Mar;120(3):271-4.
• 10. Ege E, Akın B, Yaralı Arslan S, Bilgili N. Sağlıklı kadınlarda cinsel fonksiyon bozukluğu sıklığı ve risk faktörleri. TÜBAV Bilim 3(1) 2010 137-144.
• 11. Osmanağaoğlu MA, Atasaral T, Baltacı D, Bozkaya H. Effect of different preparations of hormone therapy on sexual dysfunction in naturally postmenopausal women. Climacteric. 2006 Dec;9(6):464-72.
• 12. Shifren JL, Avis NE. Surgical menopause: effects on psychological well-being and sexuality. Menopause. 2007 May-Jun;14(3 Pt 2):586-91.
• 13. Rohl J, Kjerulff K, Langenberg P, Steege J. Bilateral oophorectomy and depressive symptoms 12 months after hysterectomy. Am J Obstet Gynecol. 2008 Jul;199(1):22.e1-5.
• 14. Demetrio FN, Rennó J Jr, Gianfaldoni A, et al. Effect of estrogen replacement therapy on symptoms of depression and anxiety in non-depressive menopausal women: a randomized double-blind, controlled study. Arch Womens Ment Health. 2011 Dec;14(6):479-86.
• 15. Baksu A, Ayas B, Citak S, Kalan A, Baksu B, Goker N. Efficacy of tibolone and transdermal estrogen therapy on psychological symptoms in women following surgical menopause. Int J Gynaecol Obstet. 2005 Oct;91(1):58-62.
• 16. Rubinow DR, Johnson SL, Schmidt PJ, Girdler S, Gaynes B. Efficacy of estradiol in perimenopausal depression: so much promise and so few answers. Depress Anxiety. 2015 Aug;32(8):539-49.
• 17. Tucker PE, Bulsara MK, Salfinger SG et al. The effects of pre-operative menopausal status and hormone replacement therapy (HRT) on sexuality and quality of life after risk-reducing salpingo-oophorectomy. Maturitas. 2016 Mar; 85: 42-8.
• 18. Goktas S. B, Gun I, Yildiz T, Sakar M. N, Caglayan S. The effect of total hysterectomy on sexual function and depression. Pak J Med Sci. 2015 May-Jun; 31(3): 700–705.
• 19. Kotz K, Alexander JL, Dennerstein L. Estrogen and androgen hormone therapy and well-being in surgically postmenopausal women. J Womens Health (Larchmt). 2006 Oct;15(8):898-908.
• 20. Aziz A, Bergquist C, Nordholm L, Möller A, Silfverstolpe G. Prophylactic oophorectomy at elective hysterectomy. Effects on psychological well-being at 1-year follow-up and its correlations to sexuality. Maturitas. 2005 Aug 16;51(4):349-57.
• 21. Nastri CO, Lara LA, Ferriani RA et al. Hormone therapy for sexual function in perimenopausal and postmenopausal women. Cochrane Database Syst Rev. 2013 Jun 5;(6):CD009672.