Current treatment options for postmenopausal vaginal atrophy

Figures & data

Figure 1 Cascade effects of the mechanism of VVA.

Abbreviation: VVA, vulvovaginal atrophy.

Table 1 Differential diagnosis of VVA

Condition	Main symptoms and signs
Vaginal infections	Vaginal discharge (leukorrhea, xanthorrhea), pruritus, bad smell
Allergic reactions	Redness, swelling, pruritus, occasionally blistering, and pain
Lichen planus	Painful, red plaques or erosions with white or violaceous borders; may extend into vagina
Lichen sclerosis	Coalescing ivory and pink plaques in butterfly of crinkled, wax-like tissue. May result in labial and clitoral hood agglutination
Ulcers and cracks in the external genitalia associated with systemic diseases: Behçet	There are intensely painful, punched-out ulcers, which are often bilateral, with a yellow-white base and red borders
Ulcers and cracks in the external genitalia associated with systemic diseases: Crohn	Mixed inflammatory lesions, fissures, and “knife-cut” ulcers of variable severity. May progress into fistulae; most commonly, in perianal or rectovaginal sites. Marked painless vulval edema may occur
Acute vulvar ulcers or Lipschütz ulcers	Acute painful genital ulcerations of the vulva or lower vagina. May appear in nonsexually active adolescent girls or young women
Other vulvovaginal ulcers	Gluten enteropathy, systemic lupus erythematosus, Stevens–Johnson syndrome, pyoderma, pemphigus vulgaris, pemphigoid, and so on
Tumors of the urogenital tract	Presented as multifocal red, white, or dark raised or eroded neoplasm lesions, or as solitary ulcer with raised or indurated edge
Extramammary Paget disease	Brick red, scaly, eczematoid plaque with sharply demarcated border and sometimes a roughened surface

Abbreviation: VVA, vulvovaginal atrophy.

Table 2 Hormonal therapy for management of vulvovaginal atrophy

Route of administration	Medication	Pharmacological preparations	Initial dosage	Maintenance dosage
Vaginal cream	Estradiol-17b	Estrace 0.01%	0.5–1 g daily for the first 2 weeks	0.5–1 g one to three times weekly
	Conjugated estrogens	Premarin 0.625 mg/g	0.5–1 g daily for the first 2 weeks	0.5–1 g one to three times weekly
Vaginal tablets	Estradiol hemihydrate	Vagifem, Yuvafem	10 µg once daily for the first 2 weeks	One or two times per week
Vaginal capsules	Estradiol-17b softgel capsules	TX-004HR	4/10/25 µg daily for 2 weeks	One or two times per week
Vaginal ring	Estradiol-17b	Estring	2 mg (releases 7.5 µg daily)	Insert for 90 days
	Estradiol acetate	Femring	12.4/24.8 mg (releases 0.05/0.1 µg daily)	Insert for 90 days
Oral	SERM ospemifene	Osphena Senshio	60 mg daily	60 mg daily

Abbreviation: SERM, selective estrogen receptor modulator.