Online citations, reference lists, and bibliographies.
← Back to Search

What Should Guide Our Patient Management Of Vulvovaginal Atrophy?

M. Shapiro
Published 2019 · Medicine

Cite This
Download PDF
Analyze on Scholarcy
Share
Abstract Genitourinary syndrome of menopause including vulvovaginal atrophy is commonly experienced by postmenopausal women, reducing their quality of life. The aim of this review is to assess current treatment options within the framework of recent management guidelines. Recommendations include use of treatments addressing both symptoms and the underlying pathophysiology, and proactive patient discussion. Both prescription and non-prescription options are recognized, including non-hormone-based approaches. Local therapy is preferable in the primary treatment of genitourinary syndrome of menopause symptoms as risk of adverse events is reduced, although long-term safety data are limited. Management of patients with a history of breast cancer requires careful consideration, although estrogen therapy has not been associated with increased risk of breast cancer or of recurrence. Treatment should consider ongoing cancer therapy. As multiple, comparable options exist, treatment choice may be due to experience and patient preference. Best management requires effective patient–physician communication and shared decision-making.
This paper references
10.1097/GME.0000000000000921
The 2017 hormone therapy position statement of The North American Menopause Society.
J. Pinkerton (2017)
10.1002/14651858.CD004417.PUB2
Delayed antibiotics for symptoms and complications of respiratory infections.
G. Spurling (2004)
10.1016/j.jsbmb.2007.09.023
Effects of intravaginal dehydroepiandrosterone on vaginal histomorphology, sex steroid receptor expression and cell proliferation in the rat
L. Berger (2008)
10.1097/GME.0000000000000956
Breast cancer, endometrial cancer, and cardiovascular events in participants who used vaginal estrogen in the Women's Health Initiative Observational Study
C. Crandall (2018)
10.4065/mcp.2009.0413
Vulvovaginal atrophy.
M. B. Mac Bride (2010)
10.1097/GME.0000000000000672
Fractional microablative CO2 laser for vulvovaginal atrophy in women treated with chemotherapy and/or hormonal therapy for breast cancer: a retrospective study
T. Pagano (2016)
10.1097/gme.0b013e3181c1ac01
Ospemifene effectively treats vulvovaginal atrophy in postmenopausal women: results from a pivotal phase 3 study
G. Bachmann (2010)
10.3109/13697137.2015.1129166
2016 IMS Recommendations on women’s midlife health and menopause hormone therapy
R. Baber (2016)
10.1016/J.BREASTDIS.2016.07.021
The Use of Vaginal Estrogen in Women With a History of Estrogen-Dependent Breast Cancer: American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice Obstet Gynecol 127:e93-e96, 2016§
S. Weitzman (2016)
10.3109/13697137.2010.522875
Recommendations for the management of postmenopausal vaginal atrophy
D. Sturdee (2010)
10.1097/gme.0b013e3181a95581
Efficacy and tolerability of local estrogen therapy for urogenital atrophy
D. Archer (2010)
10.1016/j.jsxm.2017.01.011
The Women's EMPOWER Survey: Women's Knowledge and Awareness of Treatment Options for Vulvar and Vaginal Atrophy Remains Inadequate.
M. Krychman (2017)
10.1097/GME.0000000000000281
Day-to-Day Impact of Vaginal Aging questionnaire: a multidimensional measure of the impact of vaginal symptoms on functioning and well-being in postmenopausal women
A. Huang (2015)
10.1097/01.AOG.0000296714.12226.0f
Efficacy of Low-Dose Estradiol Vaginal Tablets in the Treatment of Atrophic Vaginitis: A Randomized Controlled Trial
G. Bachmann (2008)
10.3109/13697137.2014.929651
A Practitioner's Toolkit for Managing the Menopause
F. Jané (2014)
The importance of obtaining a sexual history.
G. Bachmann (2000)
10.1016/j.steroids.2013.09.003
Tissue selectivity of ospemifene: Pharmacologic profile and clinical implications
L. Kangas (2013)
10.3109/13697137.2014.947254
Vaginal administration of estradiol: effects of dose, preparation and timing on plasma estradiol levels
R. Santen (2015)
10.1111/jsm.12686
Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society.
D. Portman (2014)
10.1002/14651858.CD001500.pub3
Local oestrogen for vaginal atrophy in postmenopausal women.
A. Lethaby (2016)
10.1097/01.AOG.0000241091.86268.6e
Breast Cancer Risk in Postmenopausal Women Using Estrogen-Only Therapy
H. Lyytinen (2006)
10.1111/jsm.12219
Androgenic action of dehydroepiandrosterone (DHEA) on nerve density in the ovariectomized rat vagina.
Georges Pelletier (2013)
10.3109/13697137.2015.1124259
Treating vulvovaginal atrophy/genitourinary syndrome of menopause: how important is vaginal lubricant and moisturizer composition?
D. Edwards (2016)
10.1111/j.1471-0528.2003.02408.x
The effect of a novel vaginal ring delivering oestradiol acetate on climacteric symptoms in postmenopausal women
H. Buckler (2003)
Osphena V R prescribing information
(2013)
10.1111/jsm.12190
Vulvar and vaginal atrophy in postmenopausal women: findings from the REVIVE (REal Women's VIews of Treatment Options for Menopausal Vaginal ChangEs) survey.
S. Kingsberg (2013)
10.1097/GME.0000000000000571
Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause
F. Labrie (2016)
10.1097/GME.0000000000000428
Treatment of pain at sexual activity (dyspareunia) with intravaginal dehydroepiandrosterone (prasterone)
D. Archer (2015)
10.6118/jmm.2015.21.2.65
The Recent Review of the Genitourinary Syndrome of Menopause
H. Kim (2015)
10.1097/01.OGX.0000462917.58355.77
Vaginal Estrogen for Genitourinary Syndrome of Menopause: A Systematic Review
D. Rahn (2015)
10.1097/GME.0000000000000309
Another option for menopausal vasomotor symptoms without negative impact on weight and sexual function.
Gloria A. Bachmann (2014)
A positive approach to female sexual health: a summary report
HY Hutcherson (2009)
Ospemifene Study Group. Ospemifene effectively treats vulvovaginal atrophy in postmenopausal women: results from a pivotal phase 3 study
GA Bachmann (2010)
10.1080/13697130500087016
Endometrial and vaginal effects of low-dose estradiol delivered by vaginal ring or vaginal tablet
E. Weisberg (2005)
10.1097/gme.0b013e31824b970a
The 2012 Hormone Therapy Position Statement of The North American Menopause Society
P. Schmidt (2012)
10.1097/GME.0000000000000921
The 2017 hormone therapy position statement of The North American Menopause Society
J. A. Pinkerton (2017)
10.1097/GME.0b013e3182a122c2
Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society
G. Bachman (2013)
Treatment of pain at sexual activity (dyspareunia) with intravaginal dehydroepiandosterone
D Archer (2015)
10.1056/nejm-jw.NA46823
Management of Genitourinary Syndrome of Menopause in Women with or at High Risk for Breast Cancer
Robert W. Rebar (2018)
10.4137/CMRH.S14498
Management of Vaginal Atrophy: Implications from the REVIVE Survey
S. Wysocki (2014)
10.1210/jc.2015-2236
Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline.
C. Stuenkel (2015)
10.1111/j.1524-4741.2011.01089.x
Current Overview of the Management of Urogenital Atrophy in Women with Breast Cancer
S. Pruthi (2011)
10.1016/j.jsbmb.2005.02.018
Effects of dehydroepiandrosterone, Premarin and Acolbifene on histomorphology and sex steroid receptors in the rat vagina
L. Berger (2005)
10.32388/sjzo65
[Vaginal dryness].
Pierre Marés (2001)
10.3389/fendo.2012.00019
Tissue-Specific Effects of Loss of Estrogen during Menopause and Aging
K. Wend (2012)
10.1097/GME.0000000000001121
Management of genitourinary syndrome of menopause in women with or at high risk for breast cancer: consensus recommendations from The North American Menopause Society and The International Society for the Study of Women's Sexual Health
S. Faubion (2018)
10.2147/IJWH.S41897
Improved compliance and patient satisfaction with estradiol vaginal tablets in postmenopausal women previously treated with another local estrogen therapy
M. J. Minkin (2013)
10.1016/j.maturitas.2014.02.015
Ospemifene, a non-oestrogen selective oestrogen receptor modulator for the treatment of vaginal dryness associated with postmenopausal vulvar and vaginal atrophy: a randomised, placebo-controlled, phase III trial.
D. Portman (2014)
10.1097/gme.0b013e31805170eb
The role of local vaginal estrogen for treatment of vaginal atrophy in postmenopausal women: 2007 position statement of The North American Menopause Society
G. Bachmann (2007)
10.1097/GME.0b013e318295236f
Clarifying Vaginal Atrophy’s Impact on Sex and Relationships (CLOSER) survey: emotional and physical impact of vaginal discomfort on North American postmenopausal women and their partners
J. Simon (2014)
10.1089/jwh.2009.1384
Recognizing and treating urogenital atrophy in postmenopausal women.
I. Goldstein (2010)
10.1097/GME.0000000000000700
An assessment of the safety and efficacy of a fractional CO2 laser system for the treatment of vulvovaginal atrophy
E. R. Sokol (2016)
10.1007/s00404-011-1955-1
Effects of intravaginal estriol and pelvic floor rehabilitation on urogenital aging in postmenopausal women
G. Capobianco (2011)
10.1097/GME.0000000000000768
Is vulvovaginal atrophy due to a lack of both estrogens and androgens?
F. Labrie (2017)
10.1097/gme.0b013e31819e8e2d
Intravaginal dehydroepiandrosterone (Prasterone), a physiological and highly efficient treatment of vaginal atrophy
F. Labrie (2009)
10.1097/GME.0000000000000401
Histological study on the effects of microablative fractional CO2 laser on atrophic vaginal tissue: an ex vivo study
S. Salvatore (2015)
10.1016/j.maturitas.2014.07.013
Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society.
D. Portman (2014)
10.1007/s10549-012-2198-y
Local estrogen therapy and risk of breast cancer recurrence among hormone-treated patients: a nested case–control study
I. Le Ray (2012)
10.18370/2309-4117.2016.32.87-98
2016 IMS recommendations on women’s midlife health and menopause hormone therapy
R. Baber (2016)
10.1002/sm2.17
Multidisciplinary Overview of Vaginal Atrophy and Associated Genitourinary Symptoms in Postmenopausal Women
I. Goldstein (2013)



This paper is referenced by
Semantic Scholar Logo Some data provided by SemanticScholar