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Ullman KE, Diem S, Forte ML, Ensrud K, Sowerby C, Zerzan N, Anthony M, Landsteiner A, Greer N, Butler M, Wilt TJ, Danan ER. Complementary and Alternative Therapies for Genitourinary Syndrome of Menopause : An Evidence Map. Ann Intern Med 2024. [PMID: 39250808 DOI: 10.7326/annals-24-00603] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Women seeking nonhormonal interventions for vulvovaginal, urinary, and sexual symptoms associated with genitourinary syndrome of menopause (GSM) may seek out complementary and alternative medicine or therapies (CAMs). PURPOSE To summarize published evidence of CAMs for GSM. DATA SOURCES Ovid MEDLINE, EMBASE, and CINAHL from inception through 11 December 2023. STUDY SELECTION Randomized controlled trials (RCTs) 8 weeks or more in duration that evaluated the effectiveness or harms of CAMs for postmenopausal women with GSM and reported 1 or more outcomes of interest, with sample sizes of 20 or more participants randomly assigned per group. DATA EXTRACTION Data were abstracted by 1 reviewer and verified by a second. DATA SYNTHESIS An evidence map approach was used to organize and describe trials. Studies were organized by type of intervention, with narrative summaries for population, study characteristics, interventions, and outcomes. Fifty-seven trials were identified that investigated 39 unique interventions. Studies were typically small (n < 200), and most were done in Iran (k = 24) or other parts of Asia (k = 9). Few trials evaluated similar combinations of populations, interventions, comparators, or outcomes. Most studies (k = 44) examined natural products (that is, herbal or botanical supplements and vitamins), whereas fewer reported on mind and body practices (k = 6) or educational programs (k = 7). Most studies reported 1 or 2 GSM symptoms, mainly sexual (k = 44) or vulvovaginal (k = 30). Tools used to measure outcomes varied widely. Most trials reported on adverse events (k = 33). LIMITATIONS Only English-language studies were used. Effect estimates, risk of bias, and certainty of evidence were not assessed. CONCLUSION There is a large and heterogeneous literature of CAM interventions for GSM. Trials were small, and few were done in North America. Standardized population, intervention, comparator, and outcomes reporting in future RCTs are needed. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality and Patient-Centered Outcomes Research Institute. (PROSPERO: CRD42023400684).
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Affiliation(s)
- Kristen E Ullman
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, Minnesota (K.E.U., C.S., N.Z., M.A., A.L., N.G.)
| | - Susan Diem
- Center for Care Delivery and Outcomes Research, VA Health Care System, and Department of Medicine, University of Minnesota, Minneapolis, Minnesota (S.D., E.R.D.)
| | - Mary L Forte
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota (M.L.F., M.B.)
| | - Kristine Ensrud
- Center for Care Delivery and Outcomes Research, VA Health Care System, and Department of Medicine and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota (K.E.)
| | - Catherine Sowerby
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, Minnesota (K.E.U., C.S., N.Z., M.A., A.L., N.G.)
| | - Nicholas Zerzan
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, Minnesota (K.E.U., C.S., N.Z., M.A., A.L., N.G.)
| | - Maylen Anthony
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, Minnesota (K.E.U., C.S., N.Z., M.A., A.L., N.G.)
| | - Adrienne Landsteiner
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, Minnesota (K.E.U., C.S., N.Z., M.A., A.L., N.G.)
| | - Nancy Greer
- Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, Minnesota (K.E.U., C.S., N.Z., M.A., A.L., N.G.)
| | - Mary Butler
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota (M.L.F., M.B.)
| | - Timothy J Wilt
- Center for Care Delivery and Outcomes Research, VA Health Care System, and Department of Medicine and Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota (T.J.W.)
| | - Elisheva R Danan
- Center for Care Delivery and Outcomes Research, VA Health Care System, and Department of Medicine, University of Minnesota, Minneapolis, Minnesota (S.D., E.R.D.)
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Mark JKK, Samsudin S, Looi I, Yuen KH. Vaginal dryness: a review of current understanding and management strategies. Climacteric 2024; 27:236-244. [PMID: 38318859 DOI: 10.1080/13697137.2024.2306892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/05/2024] [Indexed: 02/07/2024]
Abstract
The issue of vaginal dryness in genitourinary syndrome of menopause (GSM) and its pervasive impact on women's quality of life is often overlooked. Extensive surveys conducted worldwide reveal limited understanding of vaginal dryness among public and health-care providers. Physician knowledge on menopause medicine varies globally, highlighting the need for standardized training. Effective communication between physicians and patients plays a crucial role in diagnosing and treating GSM symptoms. There are multiple treatment options to improve vaginal lubrication, including hormonal and non-hormonal therapies, along with lifestyle modifications. Tailoring treatments to individual patient preferences is crucial for compliance. Overall, GSM is multifaceted, from the prevalence of vaginal dryness to the nuances of treatment preferences. The urgency of widespread education and awareness of this matter must be underscored to meet the aim of enhancing the well-being and quality of life for women.
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Affiliation(s)
- J K K Mark
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - S Samsudin
- Obstetrics and Gynaecology Department, Seberang Jaya Hospital, Penang, Malaysia
- Clinical Research Centre, Seberang Jaya Hospital, Penang, Malaysia
| | - I Looi
- Clinical Research Centre, Seberang Jaya Hospital, Penang, Malaysia
- Medical Department, Seberang Jaya Hospital, Penang, Malaysia
| | - K H Yuen
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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Ni Y, Lian J. Carbon dioxide laser therapy for the management of genitourinary syndrome of menopause: A meta‑analysis of randomized controlled trials. Exp Ther Med 2024; 27:10. [PMID: 38223331 PMCID: PMC10785041 DOI: 10.3892/etm.2023.12297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/21/2023] [Indexed: 01/16/2024] Open
Abstract
Genitourinary symptoms of menopause (GSM) affect ~50% of women after menopause. Recently, CO2 laser therapy has been used for managing GSM but without high quality evidence. The present review assessed the effectiveness of CO2 laser therapy in the management of GSM. PubMed, Embase, Web of Science, CENTRAL and Scopus databases were searched for randomized controlled trials (RCTs), published up to June 30, 2023, comparing CO2 laser and sham laser treatments for GSM management. The outcomes of interest included Female Sexual Function Index (FSFI), Vaginal Health Index (VHI) and visual analog scale (VAS) for dyspareunia, dryness, burning, itching and dysuria. A total of seven RCTs were included in the review and meta-analysis, with 6/7 studies using three sessions of laser therapy, 4-8 weeks apart. Meta-analysis demonstrated no statistically significant difference in FSFI [mean difference (MD), -1.48; 95% CI, -5.85, 2.89; I2=45%] and VHI scores (MD, -0.18; 95% CI, -1.66, 1.31; I2 =72%) between laser and control groups. Meta-analysis also demonstrated no statistically significant difference in VAS scores for dyspareunia (MD, -1.63; 95% CI; -4.06, 0.80; I2=91%), dryness (MD, -1.30; 95% CI, -3.14, 0.53; I2=75%), burning (MD, -0.76; 95% CI, -2.03; 0.51 I2=56%), itching (MD, -0.28; 95% CI, -0.95, 0.38; I2=0%) and dysuria (MD, 0.15; 95% CI, -0.37, 0.67; I2=23%) between the groups. The included RCTs had low risk of bias. In conclusion, meta-analyses of high-quality sham-controlled RCTs indicated that CO2 may not have any beneficial effect on GSM. Limited data and high heterogeneity in meta-analyses in this area of research are important limitations that need to be addressed by future RCTs.
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Affiliation(s)
- Yihua Ni
- Department of Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
| | - Junyu Lian
- Department of Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
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Hassanein MM, Huri HZ, Abduelkarem AR, Baig K. Therapeutic Effects of Vitamin D on Vaginal, Sexual, and Urological Functions in Postmenopausal Women. Nutrients 2023; 15:3804. [PMID: 37686835 PMCID: PMC10490181 DOI: 10.3390/nu15173804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Recent years have witnessed the emergence of growing evidence concerning vitamin D's potential role in women's health, specifically in postmenopausal women. This evidence also includes its connection to various genitourinary disorders and symptoms. Numerous clinical studies have observed improvements in vulvovaginal symptoms linked to the genitourinary syndrome of menopause (GSM) with vitamin D supplementation. These studies have reported positive effects on various aspects, such as vaginal pH, dryness, sexual functioning, reduced libido, and decreased urinary tract infections. Many mechanisms underlying these pharmacological effects have since been proposed. Vitamin D receptors (VDRs) have been identified as a major contributor to its effects. It is now well known that VDRs are expressed in the superficial layers of the urogenital organs. Additionally, vitamin D plays a crucial role in supporting immune function and modulating the body's defense mechanisms. However, the characterization of these effects requires more investigation. Reviewing existing evidence regarding vitamin D's impact on postmenopausal women's vaginal, sexual, and urological health is the purpose of this article. As research in this area continues, there is a potential for vitamin D to support women's urogenital and sexual health during the menopausal transition and postmenopausal periods.
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Affiliation(s)
- Mohammed M. Hassanein
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur 50603, Malaysia;
| | - Hasniza Zaman Huri
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur 50603, Malaysia;
| | - Abduelmula R. Abduelkarem
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, University City Road—University City, Sharjah P.O. Box 27272, United Arab Emirates;
- Research Institute for Medical and Health Sciences, University of Sharjah, University City Road—University City, Sharjah P.O. Box 27272, United Arab Emirates
| | - Kauser Baig
- Department of Obstetrics and Gynecology, University Hospital Sharjah, Sharjah P.O. Box 27272, United Arab Emirates;
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