The effect of serotonin reuptake inhibitors on the vaginal epithelium in postmenopausal women

Abstract

Purpose: Selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs) are used as alternative treatments for the vasomotor symptoms of menopause in women who are unwilling or unable to receive hormone therapy. These agents have been associated with sexual dysfunction and xerostomia (dry mouth), but the effect on the vagina has not been studied. The objective of this study was to determine the effect of SSRIs and SNRIs on the vaginal epithelium and sexual function in postmenopausal women, using both subjective and objective measures.

Materials and methods: A cross-sectional study of postmenopausal women not using any local or systemic estrogen therapy was conducted. The main outcomes included the Female Sexual Function Index (FSFI), vaginal epithelial maturation index (MI), and pH.

Results: Sixty-six women were recruited, 30 using SSRIs/SNRIs and 36 who were not (control). Both the proportion of superficial vaginal epithelial cells and the total MI were higher in the SSRI/SNRI group (p = 0.006 and p = 0.047, respectively). There were no significant differences in FSFI scores, vaginal pH, or total MI values.

Conclusion: The use of serotonin reuptake inhibiting drugs does not appear to have a negative influence on the vaginal epithelium and associated vaginal atrophy.

Chinese abstract

目的：选择性5-羟色胺再摄取抑制剂（SSRIs）和5-羟色胺去甲肾上腺素再摄取抑制剂（SNRIs）是用来治疗女性更年期血管舒缩症状的替代疗法。不愿意或不能接受激素治疗的人。这些药物与性功能障碍和口干（口干）有关, 但对阴道的影响尚未研究。本研究的目的是通过主观和客观测量方法, 确定SSRIs和SNRIs对绝经后妇女阴道上皮和性功能的影响。

材料和方法：对绝经后未使用任何局部或全身雌激素治疗的妇女进行了横断面研究, 主要结局指标包括女性性功能指数（FSFI）、阴道上皮成熟指数（MI）和PH值。

结果：招募了66名妇女, 30名使用SSRIs/SNRIs, 36名未使用SSRIs/SNRIs的妇女（对照组）。SSRI/SNRI组浅表阴道上皮细胞和总MI指数均较高（分别为P = 0.006和P = 0.047）。两组的FSFI评分、阴道PH值或总MI指数无显著差异。

结论：使用血清素再摄取抑制药物似乎对阴道上皮和相关的阴道萎缩没有负面影响。

Keywords:

• Selective serotonin reuptake inhibitor
• serotonin–norepinephrine reuptake inhibitor
• menopause
• maturation index
• vaginal atrophy

Acknowledgements

The authors would like to thank Dr Namsha Al-Buriki, Dr Lina Huang, and Dr Marie Christakis for helping with the recruitment of patients, as well as the staff of the Women’s Unit at Mount Sinai Hospital.

Potential conflict of interest

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by Department of Obstetrics and Gynecology, Mount Sinai Hospital.