Objectives Background: Besides experiencing vasomotor symptoms, women after surgical menopause report moderate to severe psychological and sexual symptoms. Objective: To meta-analyze the effect of estrogen, estrogen-progesterone and testosterone replacement therapy on psychological well-being and sexual functioning in women after surgical menopause.

Search strategy Medline/Pubmed, EMBASE and PsychInfo were systematically searched until November 2020. Selection criteria: Randomized controlled trials (RCTs) investigating the effect of systemic hormone replacement therapy (HRT) on psychological well-being and sexual functioning in surgically menopausal women were eligible for inclusion. Data collection and analysis: Two independent authors performed study selection, risk of bias assessment and data extraction. Standardized mean differences (SMDs) of the primary outcomes were calculated.

Results Twelve studies were included that investigated the effect of HRT on short (≤12 weeks) or medium term (13–26 weeks). Estrogen-progesterone had a beneficial effect on depressed mood (SMD -0.87, 95%CI:-1.30 to -0.45). Testosterone had a beneficial effect on overall sexual functioning (SMD 0.38, 95%CI 0.11–0.65) and sexual desire (SMD 0.38, 95%CI 0.19–0.56).

Conclusions and implications: Estrogen-progesterone may beneficially affect psychological symptoms after surgical menopause. Testosterone seems to improve sexual desire and overall sexual functioning. As the nature of the studies highly varied and bias could not be excluded, the results of our meta-analysis should be interpreted with great caution. Independent randomized controlled clinical trials investigating the effects of estrogen-progesterone and testosterone on psychological and sexual symptoms after surgical menopause are highly mandatory.