151
|
Affiliation(s)
- P. Cox
- Department of Gynaecology, Queen Charlotte’s and Chelsea Hospital, London, UK
| | - N. Panay
- Department of Gynaecology, Queen Charlotte’s and Chelsea Hospital, London, UK
- Department of Gynaecology, Chelsea and Westminster Hospital, London, UK
- Department of Gynaecology, Imperial College London, London, UK
| |
Collapse
|
152
|
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. Menopause 2019; 25:596-608. [PMID: 29762200 DOI: 10.1097/gme.0000000000001121] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The objective of The North American Menopause Society (NAMS) and The International Society for the Study of Women's Sexual Health (ISSWSH) Expert Consensus Panel was to create a point of care algorithm for treating genitourinary syndrome of menopause (GSM) in women with or at high risk for breast cancer. The consensus recommendations will assist healthcare providers in managing GSM with a goal of improving the care and quality of life for these women. The Expert Consensus Panel is comprised of a diverse group of 16 multidisciplinary experts well respected in their fields. The panelists individually conducted an evidence-based review of the literature in their respective areas of expertise. They then met to discuss the latest treatment options for genitourinary syndrome of menopause (GSM) in survivors of breast cancer and review management strategies for GSM in women with or at high risk for breast cancer, using a modified Delphi method. This iterative process involved presentations summarizing the current literature, debate, and discussion of divergent opinions concerning GSM assessment and management, leading to the development of consensus recommendations for the clinician.Genitourinary syndrome of menopause is more prevalent in survivors of breast cancer, is commonly undiagnosed and untreated, and may have early onset because of cancer treatments or risk-reducing strategies. The paucity of evidence regarding the safety of vaginal hormone therapies in women with or at high risk for breast cancer has resulted in avoidance of treatment, potentially adversely affecting quality of life and intimate relationships. Factors influencing decision-making regarding treatment for GSM include breast cancer recurrence risk, severity of symptoms, response to prior therapies, and personal preference.We review current evidence for various pharmacologic and nonpharmacologic therapeutic modalities in women with a history of or at high risk for breast cancer and highlight the substantial gaps in the evidence for safe and effective therapies and the need for future research. Treatment of GSM is individualized, with nonhormone treatments generally being first line in this population. The use of local hormone therapies may be an option for some women who fail nonpharmacologic and nonhormone treatments after a discussion of risks and benefits and review with a woman's oncologist. We provide consensus recommendations for an approach to the management of GSM in specific patient populations, including women at high risk for breast cancer, women with estrogen-receptor positive breast cancers, women with triple-negative breast cancers, and women with metastatic disease.
Collapse
|
153
|
Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments: a retrospective study. Menopause 2019; 25:657-662. [PMID: 29286986 DOI: 10.1097/gme.0000000000001053] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Vulvovaginal atrophy (VVA) is a condition frequently observed in menopause. Its symptoms can significantly affect the quality of life of patients. Since VVA is related to estrogen deficiency, chemotherapy and hormone therapy for breast cancer (BC) might cause VVA by inducing menopause. Given the lack of effective treatment for VVA in BC survivors, we retrospectively evaluated the efficacy and tolerability of fractional microablative CO2 laser therapy in these patients. METHODS We treated 82 BC survivors with three cycles of CO2 laser after failure of topical nonestrogenic therapy. The severity of symptoms was assessed with a visual analog scale (VAS) at baseline and after completion of laser therapy. Differences in mean VAS scores of each symptom before and after treatment were assessed with multiple t tests for pairwise comparisons. Multivariate analyses were used to adjust the final mean scores for the main confounding factors. RESULTS Pre versus post-treatment differences in mean VAS scores were significant for sensitivity during sexual intercourse, vaginal dryness, itching/stinging, dyspareunia and dysuria (P < 0.001 for all), bleeding (P = 0.001), probe insertion (P = 0.001), and movement-related pain (P = 0.011). Multivariate analyses confirmed that results were significant, irrespective of patients' age and type of adjuvant therapy. CONCLUSION This study shows that CO2 laser treatment is effective and safe in BC patients with iatrogenic menopause. However, the optimal number of cycles to administer and the need for retreatment remain to be defined. Prospective trials are needed to compare CO2 laser therapy with therapeutic alternatives.
Collapse
|
154
|
Palacios S, Combalia J, Emsellem C, Gaslain Y, Khorsandi D. Therapies for the management of genitourinary syndrome of menopause. Post Reprod Health 2019; 26:32-42. [PMID: 31387514 DOI: 10.1177/2053369119866341] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction The genitourinary syndrome of menopause is a new term that describes various menopausal symptoms and signs including not only genital symptoms (dryness, burning, and irritation) and sexual symptoms (lack of lubrication, discomfort or pain, and impaired function), but also urinary symptoms (urgency, dysuria, and recurrent urinary tract infections). Methods We conducted a systematic scoping review of data in women therapies with genitourinary syndrome of menopause or vulvovaginal atrophy in peer-reviewed, English-language publications in the last 20 years. Results The terms vulvovaginal atrophy and atrophic vaginitis, which were generally used up until recently, had a limitation because they did not cover the full spectrum of symptoms and did not imply that the symptoms are related to a decreased sex steroid level in menopause. The concept of genitourinary syndrome of menopause was recently introduced and has been gaining widespread use. Since genitourinary syndrome of menopause may have a profound negative impact on the quality of life of postmenopausal women, patients should be made aware of these problems and treated with an appropriate effective therapy. Therefore, in this review we introduce therapies for this syndrome, both local and systemic, and discuss the importance of genitourinary syndrome of menopause comprehension and the need to have an active treatment of this syndrome in postmenopausal women. Conclusion The increasing number of therapies for menopausal symptoms opens up new options. In addition, new products have been designed and developed by pharmaceutical companies as new possibilities for patients who did not have any treatment available and also to improve compliance.
Collapse
Affiliation(s)
| | | | | | | | - Danial Khorsandi
- Procare Health Iberia, Barcelona, Spain.,Faculty of Pharmacy, University of Barcelona, Barcelona, Spain.,Harvard-MIT's Division of Health Science and Technology, Cambridge, USA
| |
Collapse
|
155
|
Vegunta S, Files J, Kling JM. Newer Name, Newer Treatments: The Genitourinary Syndrome of Menopause. J Womens Health (Larchmt) 2019; 28:897-899. [PMID: 31334693 DOI: 10.1089/jwh.2019.7913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Suneela Vegunta
- 1Division of Women's Health, Internal Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Julia Files
- 2Medallion Division, Mayo Clinic, Scottsdale, Arizona
| | - Juliana M Kling
- 1Division of Women's Health, Internal Medicine, Mayo Clinic, Scottsdale, Arizona
| |
Collapse
|
156
|
Sussman TA, Kruse ML, Thacker HL, Abraham J. Managing Genitourinary Syndrome of Menopause in Breast Cancer Survivors Receiving Endocrine Therapy. J Oncol Pract 2019; 15:363-370. [DOI: 10.1200/jop.18.00710] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Patients with breast cancer receiving antiestrogen therapy, specifically aromatase inhibitors, often suffer from vaginal dryness, itching, irritation, dyspareunia, and dysuria, collectively known as genitourinary syndrome of menopause (GSM). GSM can decrease quality of life and is undertreated by oncologists because of fear of cancer recurrence, specifically when considering treatment with vaginal estrogen therapy because of unknown levels of systemic absorption of estradiol. In this article, we review the available literature for treatment of GSM in patients with breast cancer and survivors, including nonhormonal, vaginal hormonal, and systemic hormonal therapy options. First-line treatment includes nonhormonal therapy with vaginal moisturizers, lubricants, and gels. Although initial studies showed significant improvement in symptoms, the US Food and Drug Administration recently issued a warning against CO2 laser therapy for treatment of GSM until additional studies are conducted. In severe or refractory GSM, after discussing risks and benefits of vaginal hormonal therapy, the low-dose 10-μg estradiol-releasing intravaginal tablet or lower-dose 4 μg estrogen vaginal insert and intravaginal dehydroepiandrosterone (prasterone) are options for treatment, because studies show minimal elevation in serum estradiol levels and significant improvement in symptoms. The decision to offer vaginal estrogen therapy must be individualized and made jointly with the patient and her oncologist.
Collapse
|
157
|
Affiliation(s)
- Ranu Patni
- Division of Gynaecologic Oncology, Prayaas Clinic, Jaipur, Rajasthan, India.,Eternal Heart Care Centre and Apex Hospital, Jaipur, Rajasthan, India. E-mail:
| |
Collapse
|
158
|
Abstract
OBJECTIVE The aim of the study was to evaluate the effects of nutraceuticals containing equol on vaginal health of postmenopausal women with vulvovaginal symptoms and dyspareunia. METHODS One hundred twenty-six natural postmenopausal women on +1b +1c (2 and 3-6 y after the final menstrual period, respectively) of the Stages of Reproductive Aging Workshop were enrolled in a nonrandomized trial. Of these, 72 women accepted to use nutraceutical (group A). The remaining 54 women refused the treatment and participated as the control group (group B). Group A was prescribed one tablet daily to take orally, for 8 months. All assessments were made at baseline and at 4 and 8 months. Determination of vaginal maturation index (VMI), evaluation of vaginal pH, and assessment of vaginal atrophy symptoms by the vaginal health index (VHI) were carried out. Dyspareunia score was also measured. RESULTS Group A had a significant increase in VMI (68 ± 5 vs 58 ± 8) and improvement of vaginal pH (4.1 ± 1.3 vs 5.1 ± 1.7) compared with baseline, mainly after 8 months of treatment (P < 0.001). Group A had an improvement of VHI after 4 (13 ± 3, P < 0.01) and 8 (16 ± 2, P < 0.001) months of nutraceutical intake. Dyspareunia reduced after 8 months (5.1 ± 1.3 vs 3.8 ± 1.2, P < 0.001) but not after 4 months (4.7 ± 1.1, P = 0.06) of treatment. Group B showed no changes from baseline evaluation (P = 0.22). CONCLUSIONS Nutraceuticals containing equol could be effective in modulating postmenopausal symptoms, particularly vaginal symptoms, and could be well accepted by the women who usually do not wish to use hormone therapy or cannot use it for medical reasons.
Collapse
|
159
|
Sipos AG, Kozma B, Poka R, Larson K, Takacs P. The Effect of Fractional CO
2
Laser Treatment on the Symptoms of Pelvic Floor Dysfunctions: Pelvic Floor Distress Inventory‐20 Questionnaire. Lasers Surg Med 2019; 51:882-886. [DOI: 10.1002/lsm.23126] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Attila Gergely Sipos
- Department of Obstetrics and GynecologyUniversity of Debrecen Faculty of Medicine 98 Nagyerdei krt 4032 Debrecen Hungary
| | - Bence Kozma
- Department of Obstetrics and GynecologyUniversity of Debrecen Faculty of Medicine 98 Nagyerdei krt 4032 Debrecen Hungary
| | - Robert Poka
- Department of Obstetrics and GynecologyUniversity of Debrecen Faculty of Medicine 98 Nagyerdei krt 4032 Debrecen Hungary
| | - Kindra Larson
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive SurgeryEastern Virginia Medical School 825 Fairfax Avenue, Suite 526 Norfolk Virginia 23507‐2007
| | - Peter Takacs
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive SurgeryEastern Virginia Medical School 825 Fairfax Avenue, Suite 526 Norfolk Virginia 23507‐2007
| |
Collapse
|
160
|
Fractional CO2 laser versus promestriene and lubricant in genitourinary syndrome of menopause: a randomized clinical trial. Menopause 2019; 26:833-840. [DOI: 10.1097/gme.0000000000001333] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
161
|
Chapitre 8 : Sexualité et ménopause. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41 Suppl 1:S103-S121. [DOI: 10.1016/j.jogc.2019.02.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
162
|
La Rosa VL, Ciebiera M, Lin LT, Fan S, Butticè S, Sathyapalan T, Jędra R, Lordelo P, Favilli A. Treatment of genitourinary syndrome of menopause: the potential effects of intravaginal ultralow-concentration oestriol and intravaginal dehydroepiandrosterone on quality of life and sexual function. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2019; 18:116-122. [PMID: 31488961 PMCID: PMC6719636 DOI: 10.5114/pm.2019.86836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 06/23/2019] [Indexed: 02/05/2023]
Abstract
The climacteric is considered a natural phase in a woman's aging process and is defined as the period starting from the decline in ovarian activity until after the end of ovarian function. Genitourinary syndrome of menopause (GSM) is commonly observed in menopausal women and is characterised by a collection of symptoms resulting from changes to the internal and external genitalia as well as the lower urinary tract. Several studies have demonstrated the close association between sexual dysfunction and symptoms related to GSM. Many medications, at different doses, have been studied over the years for the treatment of the symptoms of GSM. More specifically, ultralow-dose intravaginal oestriol and intravaginal dehydroepiandrosterone (DHEA) are reported to improve symptoms, signs, and quality of life of women with GSM, and they are safe owing to their specific local effect. While the dosage and the administration of intravaginal DHEA are well defined, the literature on intravaginal oestriol is less uniform: different doses and times of administration are proposed with different possible combinations with other non-pharmacological therapies, although a more standardised treatment may be necessary. The aim of this review is to summarise the available data about the effects of ultralow-concentration oestriol and intravaginal DHEA on the menopause-related symptoms, quality of life, and sexual function of women affected by GSM.
Collapse
Affiliation(s)
| | - Michał Ciebiera
- Second Department of Obstetrics and Gynaecology, The Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Li-Te Lin
- Department of Obstetrics and Gynaecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shangrong Fan
- Department of Obstetrics and Gynaecology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Salvatore Butticè
- Department of Urology, San Giovanni di Dio Hospital, Agrigento, Italy
| | - Thozhukat Sathyapalan
- Department of Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School, University of Hull, Hull, UK
| | - Robert Jędra
- Second Department of Obstetrics and Gynaecology, The Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Alessandro Favilli
- Section of Obstetrics and Gynaecology, Department of Surgical and Biomedical Sciences, Santa Maria Della Misericordia Hospital, University of Perugia, Perugia, Italy
| |
Collapse
|
163
|
Palacios S, González SP, Fernández-Abellán M, Manubens M, García-Alfaro P. Impact Of Vulvovaginal Atrophy Of Menopause In Spanish Women: Prevalence And Symptoms According To The EVES Study. Sex Med 2019; 7:207-216. [PMID: 30885552 PMCID: PMC6522940 DOI: 10.1016/j.esxm.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/03/2019] [Accepted: 01/12/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction The prevalence of menopausal women with confirmed vulvovaginal atrophy (VVA) oscillates between 67–98%. Aim To assess the prevalence of postmenopausal women with VVA confirmed by gynecologic clinical assessment among all women attending menopause centers in Spain, as well as to describe the impact of VVA on quality of life and sexual functioning. Methods Women aged 45–75 years old with the last menstrual period >12 months before were included in a cross-sectional study. Main Outcome Measures Women with ≥1 VVA symptoms filled out a number of questionnaires, including EuroQoL, Day-to-Day Impact of Vaginal Aging, Female Sexual Function Index, and Female Sexual Distress Scale-revised. A gynecologic examination was performed to confirm diagnosis. Results 1,177 evaluable patients were included. VVA was confirmed in 87.3% of the patients. Almost 80% of women who acknowledged being sexually active (n = 717) presented pain during intercourse. As compared with patients without confirmed VVA (n = 66), patients with confirmed VVA (n = 1,028) were significantly older (P < .0001), had lower rates of sexual activity (P < .05), and used more VVA treatments (P < .05). Severe vaginal atrophy and severe vulvar atrophy were more prevalent in VVA-confirmed women (P < .0001, in both cases). No differences regarding the confirmation of VVA were observed for EuroQoL and Day-to-Day Impact of Vaginal Aging quality-of-life questionnaires. Sexual function measured through the Female Sexual Function Index score was significantly reduced in sexually-active patients with confirmed VVA (P < .05). Conclusion VVA signs and symptoms are highly prevalent in Spanish postmenopausal women. Confirmation of VVA diagnosis was associated with impaired sexual function. The early recognition of VVA symptoms should be actively promoted in medical practice, instead of waiting until signs appear to exclude other reasons for VVA and to manage treatment effectively. Palacios S, González SP, Fernández-Abellán M, et al. Impact of Vulvovaginal Atrophy of Menopause in Spanish Women: Prevalence and Symptoms According to the EVES Study. Sex Med 2019;7:207–216.
Collapse
|
164
|
▼Ospemifene for vulvar and vaginal atrophy. Drug Ther Bull 2019; 57:89-92. [PMID: 31142564 DOI: 10.1136/dtb.2019.000011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/21/2019] [Accepted: 03/21/2019] [Indexed: 11/03/2022]
|
165
|
Bober SL, Kingsberg SA, Faubion SS. Sexual function after cancer: paying the price of survivorship. Climacteric 2019; 22:558-564. [PMID: 31090466 DOI: 10.1080/13697137.2019.1606796] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sexual dysfunction is one of the most prevalent and distressing treatment side effects for millions of female cancer survivors, yet the majority of survivors do not receive necessary information, support, or treatment for these sexual consequences. Cancer can devastate the body and impair sexual function and body image. Furthermore, all primary modalities of cancer treatment (surgery, radiotherapy, chemotherapy, and hormonal therapy) have the potential to negatively impact sexual function. Assessment and identification by clinicians can be done efficiently and easily with short validated tools using a style of inquiry which starts by acknowledging how common sexual dysfunction is amongst cancer survivors rather than asking direct questions. Sexual concerns are impacted by psychological, biological, and interpersonal factors, and a multidisciplinary approach to treatment allows clinicians to comfortably inquire, assess, and refer if treatment is beyond their comfort or expertise.
Collapse
Affiliation(s)
- S L Bober
- Dana-Farber Cancer Institute, Brigham and Women's Hospital , Boston , MA , USA.,Department of Psychosocial Oncology and Palliative Care, Harvard Medical School , Boston , MA , USA
| | - S A Kingsberg
- Department of Obstetrics and Gynecology, MacDonald Women's Hospital, University Hospitals Cleveland Medical Center , Cleveland , OH , USA
| | - S S Faubion
- Mayo Clinic Center for Women's Health and Department of General Internal Medicine, Mayo Clinic , Rochester , MN , USA
| |
Collapse
|
166
|
Parish SJ, Hahn SR, Goldstein SW, Giraldi A, Kingsberg SA, Larkin L, Minkin MJ, Brown V, Christiansen K, Hartzell-Cushanick R, Kelly-Jones A, Rullo J, Sadovsky R, Faubion SS. The International Society for the Study of Women's Sexual Health Process of Care for the Identification of Sexual Concerns and Problems in Women. Mayo Clin Proc 2019; 94:842-856. [PMID: 30954288 DOI: 10.1016/j.mayocp.2019.01.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/10/2018] [Accepted: 01/16/2019] [Indexed: 12/20/2022]
Abstract
Sexual problems are common in women of all ages. Despite their frequency and impact, female sexual dysfunctions (FSDs) are often unrecognized and untreated in clinical settings. In response, the International Society for the Study of Women's Sexual Health convened a multidisciplinary, international expert panel to develop a process of care (POC) that outlines recommendations for identification of sexual problems in women. This POC describes core and advanced competencies in FSD for clinicians who are not sexual medicine specialists and serve as caregivers of women and, therefore, is useful for clinicians with any level of competence in sexual medicine. The POC begins with the expectation of universal screening for sexual concerns, proceeds with a 4-step model (eliciting the story, naming/reframing attention to the problem, empathic witnessing of the patient's distress and the problem's impact, and referral or assessment and treatment) that accommodates all levels of engagement, and delineates a process for referral when patients' needs exceed clinician expertise. Distressing problems related to desire, arousal, and orgasm affect 12% of women across the lifespan. Low desire is the most common sexual problem, but sexual pain and other less common disorders of arousal and orgasm are also seen in clinical practice. Screening is best initiated by a ubiquity statement that assures the patient that sexual concerns are common and can be revealed. Patient-centered communication skills facilitate and optimize the discussion. The goal of the POC is to provide guidance to clinicians regarding screening, education, management, and referral for women with sexual problems.
Collapse
Affiliation(s)
- Sharon J Parish
- Department of Medicine and Department of Psychiatry, Weill Cornell Medical College, New York, NY.
| | - Steven R Hahn
- Department of OB/GYN, Albert Einstein College of Medicine, Bronx, NY
| | | | - Annamaria Giraldi
- Department of Clinical Medicine and Department of Family and Community Medicine, Sexological Clinic, Psychiatric Center Copenhagen, University of Copenhagen, Denmark
| | - Sheryl A Kingsberg
- Department of OB/GYN, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, OH
| | - Lisa Larkin
- Lisa Larkin MD and Associates, Cincinnati, OH
| | - Mary Jane Minkin
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | | | | | | | | | - Jordan Rullo
- Department of Psychology and Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Richard Sadovsky
- Department of Family Medicine, SUNY-Downstate Medical Center, Brooklyn, NY
| | - Stephanie S Faubion
- Center for Women's Health and Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
167
|
The burden of vulvovaginal atrophy on women's daily living: implications on quality of life from a face-to-face real-life survey. Menopause 2019; 26:485-491. [DOI: 10.1097/gme.0000000000001260] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
168
|
Takacs P, Kozma B, Erdodi B, Jakab A, Larson K, Poka R. Zinc-containing Vaginal Moisturizer Gel Improves Postmenopausal Vulvovaginal Symptoms: A Pilot Study. J Menopausal Med 2019; 25:63-68. [PMID: 31080791 PMCID: PMC6487289 DOI: 10.6118/jmm.2019.25.1.63] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/19/2019] [Accepted: 03/04/2019] [Indexed: 11/24/2022] Open
Abstract
Objectives Although vaginal estrogen is highly effective in alleviating genitourinary symptoms of menopause (GSM), some women are reluctant to use hormonal treatment. Our aim was to evaluate the effect of a zinc-containing vaginal moisturizer gel on GSM. Methods Women with GSM were enrolled. Patients were asked to use the vaginal gel daily for 2 weeks. Vaginal Health Index (VHI) was calculated. Visual analogue scale (VAS) was obtained on vaginal pain, dryness, burning, itching, dyspareunia and dysuria before and 2 weeks after the completion of treatment. Vaginal cytology was obtained. Vulvovaginal symptom questionnaire (VSQ-21) was used to assess subjective symptoms. Results Thirty-seven women with GSM participated in the study. The VHI improved significantly (mean ± standard deviation, 13 ± 4 before vs. 17 ± 4 after treatment, P < 0.01). The patient reported VAS combined score was significantly lower after the treatment (18 ± 14 before vs. 7 ± 12 after treatment, P < 0.01). The largest improvement occurred in vaginal dryness. The maturation value did not change significantly. There were no signs of inflammation on vaginal cytology. VSQ-21 combined scores also improved significantly (7.9 ± 5.5 before vs. 2.7 ± 3.6 after the intervention, P < 0.01). Side effects were rare and minor. Conclusions Novel zinc-containing vaginal moisturizer gel significantly improves postmenopausal vulvovaginal symptoms without serious side effects.
Collapse
Affiliation(s)
- Peter Takacs
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Bence Kozma
- Department of Obstetrics and Gynecology, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| | - Balazs Erdodi
- Department of Obstetrics and Gynecology, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| | - Attila Jakab
- Department of Obstetrics and Gynecology, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| | - Kindra Larson
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Robert Poka
- Department of Obstetrics and Gynecology, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| |
Collapse
|
169
|
Maher CF, Biuttini M. No vaginal estrogen therapy arm in an RCT trial on genitourinary syndrome of menopause is a concern. Climacteric 2019; 22:426. [DOI: 10.1080/13697137.2019.1597842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Christopher F. Maher
- Royal Brisbane and Womens Hospital, University of Queensland, Brisbane, Australia
| | | |
Collapse
|
170
|
Menopausal hormone therapy in questions and answers - a manual for physicians of various specialties. MENOPAUSE REVIEW 2019; 18:1-8. [PMID: 31114451 PMCID: PMC6528039 DOI: 10.5114/pm.2019.84150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 03/22/2019] [Indexed: 11/17/2022]
Abstract
This manual has been prepared by the Expert Team of the Polish Menopause and Andropause Society for physicians representing various medical specialties who see patients with menopausal symptoms in their daily practice. In order to make the manual as practical as possible, the current state of knowledge on menopausal hormone therapy (MHT) is presented in the form of questions and answers. They address issues which are essential for initiating and managing MHT based on the most up-to-date treatment algorithms and, at the same time, in line with the old maxim "primum non nocere".
Collapse
|
171
|
Genitourinary syndrome of menopause: effects on related factors, quality of life, and self-care power. MENOPAUSE REVIEW 2019; 18:15-22. [PMID: 31114453 PMCID: PMC6528038 DOI: 10.5114/pm.2019.84152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 03/15/2019] [Indexed: 11/22/2022]
Abstract
Introduction This study aimed to determine the effects of genitourinary syndrome of menopause on related factors, quality of life, and self-care power. Material and methods This case-control epidemiological study included 300 postmenopausal women aged 48-60 years who were divided into two groups: the case group (141) with genitourinary syndrome and the control group (159) without genitourinary syndrome. Data were evaluated by chi-square and t-tests in independent groups and logistic regression analysis. Results The incidence of genitourinary syndrome of menopause was 0.61 times higher in women with a lower educational level than in those with a high educational level, 0.44 times higher in those with chronic disease than in those without, 2.54 times higher in those who continuously used medication than in those who did not, and 2.45 times higher in those with urinary incontinence than in those without. The mean Self-Care Power Scale score was significantly higher in the control group (101.52 ±21.50) than in the case group (83.96 ±25.64). The mean Menopause-Specific Quality of Life Scale score was significantly higher in the case group (65.52 ±33.47) than in the control group (37.06 ±25.81). Conclusions Low educational level, chronic disease, urinary incontinence, and continuous drug use are associated with genitourinary syndrome of menopause, which negatively affects the quality of life and self-care power in women.
Collapse
|
172
|
Vaginal estrogen in the treatment of genitourinary syndrome of menopause and risk of endometrial cancer: an assessment of recent studies provides reassurance. Menopause 2019; 24:1329-1332. [PMID: 29040220 DOI: 10.1097/gme.0000000000000996] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
173
|
Genitourinary syndrome of menopause: in their own words—development of a new patient-reported outcome measure. Menopause 2019; 26:335-336. [DOI: 10.1097/gme.0000000000001309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
174
|
Singh P, Chong CYL, Han HC. Effects of Vulvovaginal Laser Therapy on Postmenopausal Vaginal Atrophy: A Prospective Study. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2018.0048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Priyanka Singh
- Department of Urogynaecology, KK Women's and Children's Hospital, Singapore, Singapore
| | | | - How Chuan Han
- Department of Urogynaecology, KK Women's and Children's Hospital, Singapore, Singapore
| |
Collapse
|
175
|
Gordhandas S, Norquist BM, Pennington KP, Yung RL, Laya MB, Swisher EM. Hormone replacement therapy after risk reducing salpingo-oophorectomy in patients with BRCA1 or BRCA2 mutations; a systematic review of risks and benefits. Gynecol Oncol 2019; 153:192-200. [DOI: 10.1016/j.ygyno.2018.12.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 12/20/2022]
|
176
|
Kim TH, Kang JW. Acupuncture for symptoms management in Korean breast cancer survivors: a prospective pilot study. Acupunct Med 2019; 37:164-174. [DOI: 10.1177/0964528419832610] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: There is an unmet need for effective treatment of the various treatment-related symptoms experienced by breast cancer survivors. These symptoms could be alleviated by acupuncture. Although several lines of evidence in Western countries suggest that acupuncture has a beneficial effect on symptoms in breast cancer survivors, few relevant studies have been conducted in Korean patients. This pilot study assessed the feasibility of acupuncture for a variety of treatment-related symptoms in Korean breast cancer survivors. Method: From October 2015 to March 2016, we recruited patients who had undergone treatment for breast cancer and subsequently reported symptoms, including aromatase inhibitor-related knee pain, vasomotor symptoms, insomnia, sexual dysfunction and post-mastectomy pain in the chest wall or shoulder. The women received 4 weeks of symptom-specific acupuncture followed by a further 4 weeks of follow-up to evaluate the feasibility of acupuncture for this indication, and its impact on common and symptom-specific outcome variables. Results: Eight study participants were recruited over a period of 6 months, six of whom completed the planned acupuncture treatment and follow-up assessments. A total of 78 acupuncture sessions were performed. We found that acupuncture was feasible, with only six minor self-limiting acupuncture-related adverse events. Most of the women felt that they had benefitted from participation in the study. The preliminary analysis indicated improvement in common symptom-specific outcomes. Conclusion: Our findings suggest that acupuncture is feasible, but low recruitment rates should be considered when considering future acupuncture research in Korean breast cancer survivors. Rigorous evaluation of this symptomatic treatment strategy is now needed in the Korean population.
Collapse
Affiliation(s)
- Tae-Hun Kim
- Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University, Seoul, South Korea
| | - Jung Won Kang
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| |
Collapse
|
177
|
Abstract
Genitourinary syndrome of menopause (GSM) describes a collection of exam findings and bothersome symptoms associated with estrogen deficiency involving changes to the labia, introitus, clitoris, vagina, urethra, and bladder. Vulvovaginal atrophy is a component of GSM. GSM is a highly prevalent medical condition with adverse effects on the health and quality of life of midlife women. There are many effective treatment options, including nonhormonal lubricants and moisturizers, physical therapy, low-dose vaginal estrogen therapy, vaginal dehydroepiandrosterone, and oral ospemifene. Despite the availability of safe and effective therapies, GSM often remains unrecognized and untreated.
Collapse
|
178
|
Simon JA, Kagan R, Archer DF, Constantine GD, Bernick B, Graham S, Mirkin S. TX-004HR clinically improves symptoms of vulvar and vaginal atrophy in postmenopausal women. Climacteric 2019; 22:412-418. [DOI: 10.1080/13697137.2019.1577379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J. A. Simon
- George Washington University School of Medicine, IntimMedicine Specialists, Washington, DC, USA
| | - R. Kagan
- Department of Gynecology and Reproductive Sciences, University of California, Sutter East Bay Medical Foundation, Berkeley, CA, USA
| | - D. F. Archer
- Clinical Research Center, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | | | | | | | | |
Collapse
|
179
|
Kaunitz AM, Pinkerton JV, Manson JE. Vaginal estrogen: Underprescribed treatment for an underdiagnosed condition of menopausal women. Maturitas 2019; 121:83-85. [DOI: 10.1016/j.maturitas.2018.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 10/28/2022]
|
180
|
Assessment of NAMS members' prescription patterns of hormone therapy before and after the 2016 NAMS Annual Meeting. Menopause 2019; 26:240-247. [PMID: 30399025 DOI: 10.1097/gme.0000000000001201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Hormone therapy (HT) prescription patterns have varied enormously over time and across specialties. The present study attempts to look at practice variation in specific controversial scenarios and to determine if attendance at The North American Menopause Society (NAMS) 2016 Annual Meeting, where the draft of the 2017 NAMS HT Position Statement was presented, had any impact on members' HT prescribing patterns. METHODS An anonymous survey with 11 case scenarios was sent to all NAMS members before and after the 2016 NAMS Annual Meeting. Pre- and postmeeting responses were pooled into a single cohort. For those who responded to both surveys, only the postmeeting survey responses were included in the cohort. The impact of attendance at the 2016 NAMS Annual Meeting was investigated by comparing paired responses with "controversial questions" between pre- and postmeeting surveys in the matched population who either attended the 2016 NAMS Annual Meeting (intervention arm) or did not (control arm). "Controversial questions" were defined as those where 25% to 75% of responders answered "YES" to a question. McNemar's test was applied to analyze paired responses using SAS statistical software, with P ≤ 0.05 being considered statistically significant. RESULTS A total of 1,786 NAMS members were surveyed before and after the 2016 NAMS meeting, 234 (13%) completed the premeeting survey, 166 (9%) completed the postmeeting survey, and 52 completed both surveys. Of the 52, 27 attended the 2016 NAMS Annual Meeting and 25 did not. The pooled cohort contains 348 responses which represents a 20% response rate. Six complex case scenarios with "controversial questions" were identified from the pooled cohort and reexamined in the intervention and control arm, respectively. In the intervention arm, significant changes toward being more likely to prescribe HT in guideline-consistent cases were noted in four out of six cases, whereas significant changes in HT use were not seen in any of six complex cases in the control arm. CONCLUSIONS NAMS members' prescribing patterns of HT vary in complex clinical scenarios. After the 2016 NAMS Annual Meeting where a draft of the 2017 NAMS HT Position Statement was presented and discussed, in four challenging and complex clinical situations a significant number of practitioners changed their prescription patterns toward prescribing HT which was consistent with the new guideline.
Collapse
|
181
|
Vale F, Rezende C, Raciclan A, Bretas T, Geber S. Efficacy and safety of a non-hormonal intravaginal moisturizer for the treatment of vaginal dryness in postmenopausal women with sexual dysfunction. Eur J Obstet Gynecol Reprod Biol 2019; 234:92-95. [DOI: 10.1016/j.ejogrb.2018.12.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/11/2018] [Accepted: 12/27/2018] [Indexed: 12/14/2022]
|
182
|
Clinician knowledge, attitudes, and barriers to management of vulvovaginal atrophy: variations in primary care and gynecology. Menopause 2019; 26:265-272. [DOI: 10.1097/gme.0000000000001198] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
183
|
Sadeghi M, Namjouyan F, Cheraghian B, Abbaspoor Z. Impact of Glycyrrhiza glabra (licorice) vaginal cream on vaginal signs and symptoms of vaginal atrophy in postmenopausal women: A randomized double blind controlled trial. J Tradit Complement Med 2019; 10:110-115. [PMID: 32257873 PMCID: PMC7109473 DOI: 10.1016/j.jtcme.2019.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 02/23/2019] [Accepted: 02/25/2019] [Indexed: 11/25/2022] Open
Abstract
Background Vaginal atrophy is one of the most common menopausal complications affecting women's quality of life. The present study aimed to investigate the impact of Glycyrrhiza glabra (licorice) vaginal cream on vaginal signs and symptoms of vaginal atrophy in postmenopausal women. Methods This randomized controlled trial was conducted on 70 menopausal women, referring to health centers of Izeh city, located in the south west of Iran, from May to November 2017. The participants with vaginal atrophy were randomly assigned into two groups of 35. One of the groups received licorice 2% vaginal cream while the other was given placebo over a period of 8 weeks. Data were analyzed using SPSS software at the significance level of 0.05. Results The results indicated that at the baseline, none of the subjects (0%) in either groups had a vaginal cells maturation Index within 65–100 in MVI category. However, after 8 weeks of therapy, it improved significantly to 82.9% in Licorice group and 11.4% in the placebo group (p < 0.001). Also, the vaginal mucus cells changed from the baseline cells to intermediate and superficial cells within and between the two groups after the treatment (p < 0.001). Finally, the pH level significantly decreased in licorice group over time (p < 0.001). Conclusion Therapeutic use of licorice vaginal cream can improve the signs and symptoms of vaginal atrophy in postmenopausal women. Accordingly, use of licorice as a natural vaginal cream in vaginal atrophy can be suggested.
Collapse
Affiliation(s)
- Mastaneh Sadeghi
- Department of Midwifery, Menopause Andropause Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Foroogh Namjouyan
- Pharmacognosy Department, Marine Pharmaceutical Research Center, Faculty of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Bahman Cheraghian
- Department of Epidemiology and Biostatistics, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zahra Abbaspoor
- Department of Midwifery, Menopause Andropause Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|
184
|
Najjarzadeh M, Mohammad Alizadeh Charandabi S, Mohammadi M, Mirghafourvand M. Comparison of the effect of hyaluronic acid and estrogen on atrophic vaginitis in menopausal women: A systematic review. Post Reprod Health 2019; 25:100-108. [PMID: 30798700 DOI: 10.1177/2053369119830818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This systematic review was conducted to compare the effectiveness of hyaluronic acid and estrogen on symptoms of atrophic vaginitis (primary outcomes) and corresponding side effects (secondary outcome). We reviewed all parallel clinical trials, systematically, to compare the effectiveness of hyaluronic acid and estrogen on atrophic vaginitis. We searched Pubmed, Embase, Web of Sciences, Cochrane library, Scopus, Google Scholar, Magiran, Scientific Information Database (Iran) and Iranian Registry of Clinical Trials, from inception to July 2018 and the reference lists of retrieved articles. Two reviewers used the Cochrane collaboration tool to assess the risk of bias independently. Five parallel controlled trials with 372 participants were included in the present systematic review. One trial reported estrogen superiority to hyaluronic acid in improving the symptoms of atrophic vaginitis. Three trials failed to show a significant statistical difference between the intervention groups. Only a trial with a high risk of bias in random allocation and blinding indicated that hyaluronic acid was more effective than estrogen in improving the symptoms of atrophic vaginitis. Hyaluronic acid is an effective drug with few side effects for the treatment of atrophic vaginitis symptoms; however, better designed trials are required to show the statistical superiority of hyaluronic acid to vaginal estrogen.
Collapse
Affiliation(s)
- Maryam Najjarzadeh
- 1 Student's Research Committee, Midwifery Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Marzyeh Mohammadi
- 1 Student's Research Committee, Midwifery Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- 3 Social Determinants of Health Research Center, Department of Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
185
|
Tovar‐Huamani J, Mercado‐Olivares F, Grandez‐Urbina JA, Pichardo‐Rodriguez R, Tovar‐Huamani M, García‐Perdomo H. Efficacy of fractional CO
2
laser in the treatment of genitourinary syndrome of menopause in Latin‐American Population: First Peruvian experience. Lasers Surg Med 2019; 51:509-515. [DOI: 10.1002/lsm.23066] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2019] [Indexed: 02/01/2023]
Affiliation(s)
| | | | | | - Rafael Pichardo‐Rodriguez
- Clinica de Urologia Avanzada UROZENLimaPerú
- Biomedical Research InstituteUniversidad Ricardo PalmaLimaPerú
| | | | | |
Collapse
|
186
|
Kingsberg SA, Schaffir J, Faught BM, Pinkerton JV, Parish SJ, Iglesia CB, Gudeman J, Krop J, Simon JA. Female Sexual Health: Barriers to Optimal Outcomes and a Roadmap for Improved Patient-Clinician Communications. J Womens Health (Larchmt) 2019; 28:432-443. [PMID: 30714849 PMCID: PMC6482896 DOI: 10.1089/jwh.2018.7352] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Although sexual health can be considered a vital sign for overall health, several barriers prevent women from receiving proper medical counseling, support, and/or care for their sexual health needs and concerns. METHODS Experts in sexual health compiled research and experience on the impediments to women receiving adequate assessment and treatment for their sexual health. Specific solutions and a roadmap for overcoming such barriers and improving patient-clinician communication are presented. RESULTS Social stigma around female sexuality remains in Western culture and as a result, women often avoid and/or are embarrassed to discuss their sexual health with their health care professionals (HCPs). Moreover, midlife women are typically unaware or have misconceptions about conditions that may adversely impact their sexual life, such as genitourinary syndrome of menopause and hypoactive sexual desire disorder. Without understanding there may be underlying medical conditions, there is also a lack of awareness that safe and effective treatments are available. Lack of training, tools, time, and limited treatment options impede HCPs from providing women with necessary sexual health support. Educating women, training HCPs, and providing communication tools to HCPs can facilitate effective dialog between patients and HCPs. More specifically, HCPs can be trained to initiate and maintain a sexual health conversation in a manner that is comfortable for women to convey sexual health needs and concerns, and for HCPs to correctly identify, diagnose, and treat the sexual problems of their female patients. CONCLUSIONS Solutions exist to address the barriers currently impeding patient-clinician interactions around sexual health.
Collapse
Affiliation(s)
- Sheryl A Kingsberg
- 1 MacDonald Women's Hospital, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | | | | | | | - Cheryl B Iglesia
- 6 MedStar Washington Hospital Center, Washington, District of Columbia
| | | | - Julie Krop
- 7 AMAG Pharmaceuticals, Waltham, Massachusetts
| | - James A Simon
- 8 George Washington University, School of Medicine, IntimMedicine Specialists, Washington, District of Columbia
| |
Collapse
|
187
|
The WISDOM survey: toward wiser care of women with vulvovaginal atrophy. Menopause 2019; 26:115-117. [DOI: 10.1097/gme.0000000000001281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
188
|
Kingsberg SA, Larkin L, Krychman M, Parish SJ, Bernick B, Mirkin S. WISDOM survey: attitudes and behaviors of physicians toward vulvar and vaginal atrophy (VVA) treatment in women including those with breast cancer history. Menopause 2019; 26:124-131. [PMID: 30130293 PMCID: PMC6365251 DOI: 10.1097/gme.0000000000001194] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/03/2018] [Accepted: 07/03/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate and compare physicians' behaviors and attitudes regarding vulvar and vaginal atrophy (VVA) treatment in menopausal women, including women with breast cancer, using an internet-based survey. METHODS The WISDOM survey queried obstetricians and gynecologists (OB/GYNs) and primary care physicians (PCPs) with 23 multipart questions assessing behaviors and attitudes towards VVA treatment. RESULTS Of 2,424 surveys sent, 945 (39%) responded and 644 (27%) were completed. Of the menopausal women seen by OB/GYNs and PCPs, 44% to 55% reported having VVA symptoms. Physicians prescribed VVA treatments primarily because of effectiveness. Only 34% of OB/GYNs and 17% of PCPs felt comfortable prescribing VVA therapies to women with a personal history of breast cancer. In general, the most common VVA treatment recommended by all was prescription therapy (49%; with or without other therapies) in the form of US Food and Drug Administration-approved vaginal estrogen creams. More OB/GYNs (72%) than PCPs (47%) disagreed that VVA was best treated with over the counter than prescription products. Out-of-pocket cost and fear of risks associated with estrogens were believed to be the main barriers for why women choose not to get treated and why they discontinue treatment. CONCLUSIONS More OB/GYNs than PCPs prescribed VVA treatment, especially vaginal estrogens, for menopausal women, but both groups generally had similar attitudes and behaviors regarding VVA treatment. Physician comfort was low when prescribing to women with a history of breast cancer, despite women's health medical societies supporting vaginal estrogen use in women with a history of estrogen-dependent breast cancer who were unresponsive to nonhormonal therapies when offered in consultation with their oncologist.
Collapse
Affiliation(s)
- Sheryl A. Kingsberg
- University Hospitals Cleveland Medical Center, MacDonald Women's Hospital, Cleveland, OH
| | - Lisa Larkin
- Lisa Larkin MD and Associates, Mariemont, OH
| | - Michael Krychman
- Southern California Center for Sexual Health and Survivorship Medicine Inc., Newport Beach, CA
| | | | | | | |
Collapse
|
189
|
Chatsiproios D, Schmidts-Winkler IM, König L, Masur C, Abels C. Topical treatment of vaginal dryness with a non-hormonal cream in women undergoing breast cancer treatment - An open prospective multicenter study. PLoS One 2019; 14:e0210967. [PMID: 30677065 PMCID: PMC6345451 DOI: 10.1371/journal.pone.0210967] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 12/30/2018] [Indexed: 12/14/2022] Open
Abstract
This open, prospective, multicenter, observational study was performed to investigate the efficacy and safety of a non-hormonal cream in women undergoing breast cancer treatment and experiencing vulvovaginal dryness symptoms. Overall, 128 patients from 22 study centers participated. The cream was applied to the vagina and vulva for 28 days. For the efficacy analysis, changes in subjective symptoms (feeling of dryness, itching, burning, pain independent of sexual intercourse, dyspareunia, urinary incontinence) were evaluated. Additionally, the following objective diagnostic findings were assessed by a physician: thinning of vaginal epithelium, redness, petechiae, and discharge. Safety and tolerability were assessed by evaluating type and frequency of adverse events, including adverse medical device-related effects. The frequency and intensity of all subjective symptoms significantly improved from baseline at 28 days (p<0.0001). Additionally, 21.4% of patients were completely free of symptoms (p<0.0001) and urinary incontinence was improved or eliminated in 30.8% of women. The overall sum score for all four objective findings was significantly improved from baseline at 28 days (p<0.0001). The frequency of petechial bleedings was significantly reduced (p<0.0001). Further, significant decreases in the severity of vaginal epithelium thinning, redness and petechiae were observed (p<0.0001). More than 88% of patients and investigators assessed the efficacy and tolerability as being good or very good. No serious adverse events were documented. This study demonstrates that the investigated cream is an effective and safe non-hormonal, topical option in the treatment of vulvovaginal dryness symptoms in patients undergoing breast cancer treatment for. However, the study duration and follow-up time of 4 weeks as well as the non-randomized trial design are limitations of the study.
Collapse
Affiliation(s)
| | | | - Lisa König
- DR. AUGUST WOLFF GmbH & CO. KG–ARZNEIMITTEL, Bielefeld, Germany
- * E-mail:
| | - Clarissa Masur
- DR. AUGUST WOLFF GmbH & CO. KG–ARZNEIMITTEL, Bielefeld, Germany
| | - Christoph Abels
- DR. AUGUST WOLFF GmbH & CO. KG–ARZNEIMITTEL, Bielefeld, Germany
| |
Collapse
|
190
|
Flint R, Cardozo L, Grigoriadis T, Rantell A, Pitsouni E, Athanasiou S. Rationale and design for fractional microablative CO 2 laser versus photothermal non-ablative erbium:YAG laser for the management of genitourinary syndrome of menopause: a non-inferiority, single-blind randomized controlled trial. Climacteric 2019; 22:307-311. [PMID: 30676818 DOI: 10.1080/13697137.2018.1559806] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Genitourinary syndrome of menopause (GSM) is a common condition affecting up to 50% of postmenopausal women and up to 70% of postmenopausal breast cancer survivors. GSM is a chronic condition with a significant impact on sexual health and quality of life. The mainstay of treatment has been with symptomatic relief using topical emollients or lubricants. Second-line treatment is with topical vaginal estrogens to restore the physiology of the vaginal epithelium. For some, the latter is not suitable or acceptable. Newer treatments with ospemifene and vaginal lasers have now been introduced. The two main types of laser currently used for the treatment of GSM are the fractional microablative CO2 laser and the non-ablative photothermal erbium:YAG laser. We present a study protocol for a multicenter, prospective, non-inferiority, single-blinded, randomized controlled trial comparing the fractional microablative CO2 laser versus the photothermal non-ablative erbium:YAG laser for the management of GSM. We will recruit 88 postmenopausal women across two sites who will be randomized to one of the two laser groups. Participants will all have GSM symptoms and a Vaginal Health Index Score < 15. All participants will receive an active treatment. Each participant will receive three applications of vaginal laser 1 month apart and will be followed up at 1 month, 6 months, and 12 months. Our primary outcomes will look at all changes of GSM symptoms (dryness, dyspareunia, itching, burning, dysuria, frequency, urgency), urinary incontinence (if present), and overall sexual satisfaction. Both subjective and objective means will be used to assess participants. The findings of this trial have the potential to allow clinicians and women suffering from GSM to make an informed decision when opting for a specific laser type. The trial will add to the current growing body of evidence for the safe use of vaginal lasers in GSM as an alternative treatment. We hope this trial will provide robust and long-term data for the safe use of both lasers.
Collapse
Affiliation(s)
- R Flint
- a King's College Hospital , London, UK
| | - L Cardozo
- a King's College Hospital , London, UK
| | - T Grigoriadis
- b First Department of Obstetrics and Gynecology , National and Kapodistrian University of Athens, 'Alexandra' Hospital , Athens , Greece
| | - A Rantell
- a King's College Hospital , London, UK
| | - E Pitsouni
- c First Department of Obstetrics and Gynecology , National and Kapodistrian University of Athens , Athens , Greece
| | - S Athanasiou
- c First Department of Obstetrics and Gynecology , National and Kapodistrian University of Athens , Athens , Greece
| |
Collapse
|
191
|
|
192
|
Kwon DH, Shin JH. Updated treatment guideline for hormone therapy in postmenopausal women. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2019. [DOI: 10.5124/jkma.2019.62.3.145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Dae-Hui Kwon
- Department of Obstetrics and Gynecology, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jung-Ho Shin
- Department of Obstetrics and Gynecology, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
193
|
Nappi RE, Martini E, Cucinella L, Martella S, Tiranini L, Inzoli A, Brambilla E, Bosoni D, Cassani C, Gardella B. Addressing Vulvovaginal Atrophy (VVA)/Genitourinary Syndrome of Menopause (GSM) for Healthy Aging in Women. Front Endocrinol (Lausanne) 2019; 10:561. [PMID: 31496993 PMCID: PMC6712495 DOI: 10.3389/fendo.2019.00561] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/31/2019] [Indexed: 12/23/2022] Open
Abstract
Vaginal health is an essential component of active and healthy aging in women at midlife and beyond. As a consequence of hormonal deprivation and senescence, the anatomy and function of urogenital tissues are significantly affected and vulvovaginal atrophy (VVA) may occur. In a high proportion of postmenopausal women, progressive and chronic VVA symptoms have a strong impact on sexual function and quality of life. The new definition of genitourinary syndrome of menopause (GSM) comprises genital symptoms (dryness, burning, itching, irritation, bleeding), sexual symptoms (dyspareunia and other sexual dysfunctions) and urinary symptoms (dysuria, frequency, urgency, recurrent urinary infections). Many variables (age, sexual activity and partnership status) influence the clinical impact VVA/GSM symptoms and attitudes of elderly women to consult for receiving effective treatments. Psychosocial factors play a critical role in sexual functioning, but the integrity of the urogenital system is as well important affecting many domains of postmenopausal women's health, including sexual function. Several international surveys have extensively documented the need to improve VVA/GSM management because of the strong impact on women's daily life and on couple's intimacy. Health care providers (HCPs) need to be proactive in the early recognition of VVA/GSM in order to preserve urogenital and sexual longevity, by using hormonal and non-hormonal strategies. The clinical diagnosis is based on genital examination to identify objective signs and on the use of subjective scales to rate most bothersome symptoms (MBS), especially vaginal dryness. Recent studies point to the importance of addressing VVA/GSM as a potential early marker of poor general health in analogy with vasomotor symptoms. Therefore, a standard of VVA/GSM care in elderly women is desirable to enhance physical, emotional and mental well-being.
Collapse
Affiliation(s)
- Rossella E. Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, University of Pavia, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- *Correspondence: Rossella E. Nappi
| | - Ellis Martini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, University of Pavia, Pavia, Italy
| | - Laura Cucinella
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, University of Pavia, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Silvia Martella
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, University of Pavia, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Lara Tiranini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, University of Pavia, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Alessandra Inzoli
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, University of Pavia, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Emanuela Brambilla
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, University of Pavia, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - David Bosoni
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, University of Pavia, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Chiara Cassani
- Obstetrics and Gynecology Unit, IRCCS San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Barbara Gardella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Obstetrics and Gynecology Unit, IRCCS San Matteo Foundation, University of Pavia, Pavia, Italy
| |
Collapse
|
194
|
Samuels JB, Garcia MA. Treatment to External Labia and Vaginal Canal With CO2 Laser for Symptoms of Vulvovaginal Atrophy in Postmenopausal Women. Aesthet Surg J 2019; 39:83-93. [PMID: 29726916 PMCID: PMC6291777 DOI: 10.1093/asj/sjy087] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Increasingly, women have sought alternatives to traditional options (lubricants, estrogen products, and hormone replacement therapy) for unwelcome vaginal changes of menopause. Objectives This study evaluated whether a series of three monthly fractional CO2 laser treatments significantly improves and maintains vaginal health indices of elasticity, fluid volume, pH level, epithelial integrity, and moisture. Self-reported symptoms of vaginal atrophy were also measured. Biopsy samples after a series of three treatments were evaluated for histological changes to vaginal canal tissue. Methods Forty postmenopausal women were treated extravaginally and internally with a fractional CO2 laser. Objective measurements of vaginal health index, as well as subjective measurements of symptoms of vulvovaginal atrophy (VVA), urinary incontinence, and sexual function were reported at baseline. Follow-up evaluations were at one, three, six, and 12 months after the third treatment. Results Vaginal health index improved significantly after the first treatment and was maintained with mean improvement of 9.6 ± 3.3 (P < 0.001) and 9.5 ± 3.3 (P < 0.001) at the 6- and 12-month follow ups, respectively. Vaginal symptoms of dryness, itching, and dyspareunia improved significantly (P < 0.05) at all evaluations. Histological findings showed increased collagen and elastin staining, as well as a thicker epithelium with an increased number of cell layers and a better degree of surface maturation. Conclusions Fractional CO2 laser treatments were well tolerated and were associated with improvement in vaginal health and amelioration of symptoms of VVA. Histological changes in the epithelium and lamina propria, caused by fractional CO2 laser treatments, correlated with clinical restoration of vaginal hydration and pH to premenopausal levels. Level of Evidence: 4
Collapse
|
195
|
|
196
|
Genitourinary syndrome of menopause - is the problem solved? State of the art 2018. MENOPAUSE REVIEW 2018; 17:168-174. [PMID: 30766464 PMCID: PMC6372854 DOI: 10.5114/pm.2018.81741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 12/27/2018] [Indexed: 12/19/2022]
Abstract
Vulvovaginal atrophy accompanied by lower urinary tract dysfunction related to low levels of estrogen and androgens is labeled as genitourinary syndrome of menopause (GSM). Although this condition affects most postmenopausal women worldwide, it seems to be underdiagnosed and undertreated. Women should be properly advised to choose an adequate treatment modality to improve their quality of life, sexual relationships and social activity. The aim of this article to is increase knowledge of GSM. The current treatment options, both hormonal and non-hormonal, are reviewed. Topical estrogen therapy still remains the gold standard, but the demand for individually tailored therapy is growing. New treatment modalities are continuously included in clinical practice. They should consider the whole personality of a woman as well as cultural and social factors. Further studies on GSM and on the effectiveness of various treatment options are necessary to achieve this purpose.
Collapse
|
197
|
Genitourinary syndrome of menopause symptom severity and impact outcome measures: are they reliable and correlated? Menopause 2018; 26:659-664. [DOI: 10.1097/gme.0000000000001287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
198
|
Bhupathiraju SN, Grodstein F, Stampfer MJ, Willett WC, Crandall CJ, Shifren J, Manson JE. Vaginal estrogen use and chronic disease risk in the Nurses' Health Study. Menopause 2018; 26:603-610. [PMID: 30562320 PMCID: PMC6538478 DOI: 10.1097/gme.0000000000001284] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To examine the associations between vaginal estrogen use and multiple health outcomes including cardiovascular disease (total myocardial infarction, stroke, and pulmonary embolism/deep vein thrombosis), cancer (total invasive, breast, endometrial, ovarian, and colorectal cancer), and hip fracture. METHODS We included postmenopausal women from the Nurses' Health Study (1982-2012) who were not current users of systemic hormone therapy at the start of the study or during follow-up. Vaginal estrogen use was self-reported on the biennial questionnaires. Information on incident health outcomes were self-reported and confirmed by medical records. We used Cox proportional hazards regression to model the multivariable adjusted hazard ratios and the 95% confidence intervals for vaginal estrogen use and multiple health outcomes. RESULTS Over 18 years of follow-up, after adjusting for covariates, risks for cardiovascular disease, cancer, and hip fracture were not different between users and nonusers of vaginal estrogen. No statistically significant increase in risk of any health outcome was observed with vaginal estrogen use. In sensitivity analyses, when we examined associations by hysterectomy status, the stratified results were generally similar to those for the total cohort. CONCLUSIONS Vaginal estrogen use was not associated with a higher risk of cardiovascular disease or cancer. Our findings lend support to the safety of vaginal estrogen use, a highly effective treatment for genitourinary syndrome of menopause.
Collapse
Affiliation(s)
- Shilpa N Bhupathiraju
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Francine Grodstein
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Meir J Stampfer
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Walter C Willett
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Carolyn J Crandall
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Jan Shifren
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - JoAnn E Manson
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
199
|
Portman DJ, Goldstein SR, Kagan R. Treatment of moderate to severe dyspareunia with intravaginal prasterone therapy: a review. Climacteric 2018; 22:65-72. [PMID: 30554531 DOI: 10.1080/13697137.2018.1535583] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The loss of sex steroids (e.g. estradiol, dehydroepiandrosterone [DHEA], progesterone) that causes menopause commonly affects a woman's general health and produces bothersome physical changes that may interfere with normal sexual and genitourinary functioning. Although both over-the-counter and prescription treatments are available, there remains a large unmet need, as less than 10% of women are treated. Adrenal DHEA and its sulfate are the most abundant steroids in humans. Here we review the development of intravaginal prasterone, the synthetic equivalent to endogenous DHEA. Prasterone is approved by the US Food and Drug Administration for the treatment of moderate to severe dyspareunia, a symptom of vulvar and vaginal atrophy, due to menopause. Prasterone has been shown to decrease the pain associated with dyspareunia, and to improve vaginal pH, as well as superficial and parabasal cell counts, while maintaining serum hormone levels within the range of those seen in normal postmenopausal women. Unlike other menopausal prescription therapies, intravaginal prasterone does not carry a boxed warning, thus allowing the clinician and patient to engage in meaningful and reassuring discussion around a new approach that treats this common, debilitating condition.
Collapse
Affiliation(s)
- D J Portman
- a Columbus Center for Women's Health Research , Columbus , OH , USA.,b Sermonix Pharmaceuticals , Columbus , OH , USA
| | - S R Goldstein
- c Department of Obstetrics and Gynecology , New York University School of Medicine , New York , NY , USA
| | - R Kagan
- d Department of Obstetrics, Gynecology, and Reproductive Sciences , University of California , San Francisco , CA , USA.,e Sutter East Bay Medical Foundation , Berkeley , CA , USA
| |
Collapse
|
200
|
Ribeiro AE, Monteiro NES, Moraes AVGD, Costa-Paiva LH, Pedro AO. Can the use of probiotics in association with isoflavone improve the symptoms of genitourinary syndrome of menopause? Results from a randomized controlled trial. Menopause 2018; 26:643-652. [PMID: 30531444 DOI: 10.1097/gme.0000000000001279] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the effect of isoflavone administration, either in conjunction with probiotic use or not, on the symptoms of genitourinary syndrome of menopause, and compare the effects with those of hormone therapy. METHODS A randomized clinical trial was conducted on 60 postmenopausal women aged 40 to 60 years, randomly assigned to receive oral isoflavone (150 mg dry extract of glycine max) alone or isoflavone plus probiotic (Lactobacillus acidophilus, Lactobacillus casei, Lactococcus lactis, Bifidobacterium bifidum, and Bifidobacterium lactis) or hormone therapy (1 mg estradiol and 0.5 mg norethisterone acetate). The urogenital symptom subscale of the Menopause Rating Scale and International Consultation on Incontinence Questionnaire-Short Form were used to assess genitourinary symptoms. Vaginal maturation value, pH, vaginal health score, and vaginal flora were used to evaluate vaginal atrophy. Equol, equol intermediate, O-dimethylangolensin, and aglycones were measured using gas chromatography coupled to mass spectrometry. RESULTS After 16 weeks of treatment, the urogenital symptoms, mainly vaginal dryness and sexual problem complaints, improved significantly in the hormone therapy group. There was a significant increase in the daidzein, glycitein, equol intermediate, and O-dimethylangolensin contents after 16 weeks in the isoflavone plus probiotic group. The maturation value, vaginal pH, and vaginal flora improved in the hormone therapy group. The vaginal health score increased in the isoflavone and hormone therapy groups. CONCLUSIONS Probiotics improved the metabolism of isoflavones after 16 weeks of treatment. However, the increase in the contents of isoflavones and their metabolites failed to yield an estrogenic effect on the urogenital tract and relieve the vulvovaginal symptoms.
Collapse
Affiliation(s)
- Ana Elisa Ribeiro
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP - Universidade Estadual de Campinas), Campinas, São Paulo, Brazil
| | | | | | | | | |
Collapse
|