Management of postmenopausal vulvovaginal atrophy: recommendations of the International Society for the Study of Vulvovaginal Disease

Abstract

Objective

To develop a best practice document for the management of postmenopausal vulvovaginal atrophy (VVA).

Method

Literature review carried out using clinical terms, treatments or interventions and comorbidity related to VVA.

Results

There is a wide variety of interventions that may produce temporal benefits for VVA. However, there are significant limitations in scientific publications concerning VVA and related issues, including variable outcome evaluations, variability in population age range, and small, often underpowered sample sizes. Therapeutic management of VVA should follow a sequential order, considering women’s age, symptoms, general health as well as treatment preference. Beneficial options include lubricants, moisturizers, vaginal estrogens (estradiol, estriol, promestriene, conjugated estrogens), androgens, prasterone, and laser application. In women with general menopausal symptoms who are candidates for systemic hormone therapy, the lowest effective dose should be used. Oral ospemifene is an effective selective estrogen receptor modulator to treat VVA. Systemic androgens have a limited role. Although laser procedures are commonly used, at this moment the International Society for the Study of Vulvovaginal Disease does not endorse its use out of the setting of clinical trials. Pelvic floor muscle training improves blood flow and elasticity of the vulvovaginal tissue. In breast cancer survivors, moisturizers and lubricants are first line therapy. However, limited absorption of low/ultra-low doses of estrogens suggests safety, especially in women under treatment with aromatase inhibitors. As clinical practice and available preparations vary between countries this text should be adapted to local circumstances.

Conclusions

There is a wide range of therapeutic options to individualize VVA treatments.

绝经后外阴阴道萎缩的管理:国际外阴阴道疾病研究协会的建议 摘要

目的：开发一个管理绝经后外阴阴道萎缩(VVA)的最佳实践文件。

方法：使用与VVA相关的临床术语、治疗或干预措施以及VVA伴随疾病进行文献综述。

结果：现在有多种多样的干预措施可能对VVA产生暂时的好处。然而, 关于VVA和相关问题的科学出版物存在很大的局限性, 包括可变的结果评估、人口年龄范围的可变性, 以及小的、通常是动力不足的样本量。VVA的治疗管理应遵循顺序, 考虑女性的年龄、症状、一般健康状况以及治疗偏好。有益的选择包括润滑剂, 保湿剂, 阴道雌激素（雌二醇, 雌三醇, 孕酮, 结合雌激素）, 雄激素, 普拉睾酮以及激光应用。对于全身性激素治疗的更年期症状女性, 应该使用最低有效剂量。口服欧司哌米芬是治疗VVA的有效选择性雌激素受体调节剂。系统性雄激素的作用是有限的。虽然普遍使用激光手术, 但目前国际外阴阴道研究协会并不认可其在临床试验中的使用。盆底肌肉训练可以改善外阴阴道组织的血流和弹性。对于乳腺癌的幸存者来说, 保湿剂和润滑剂是一线治疗方法。然而, 低/超低剂量雌激素的有限吸收显示出安全性, 尤其是在使用芳香化酶抑制剂治疗的女性中。由于各国的临床实践和可用制剂不同, 本文应根据当地情况进行调整。由于各国的临床实践和可用制剂不同, 本文应根据当地情况进行调整。

总结：个体化VVA治疗有多种治疗选择。

Keywords:

• Vulvovaginal atrophy
• estriol
• estrogens
• prasterone
• androgens
• SERMs
• ospemifene
• vaginal moisturizers
• lubricants
• laser
• breast cancer

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Acknowledgements

The authors thank the ISSVD Executive Council for their helpful comments.

Disclosure statement

PVB received travel and speaker fees from Seegene^® and Roche^®. The other authors have declared they have no conflicts of interest.

Provenance and peer review

This is a Position Statement of the ISSVD.

Additional information

Funding

No funding was sought or secured for this Position Statement.