Different local estrogen therapies for a tailored approach to GSM

Abstract

Local estrogen therapy (LET) is the mainstay of treatment for vaginal dryness, dyspareunia and other urogenital symptoms because it may reverse some pathophysiological mechanisms associated with decreasing endocrine function and increasing aging. Over the years, several vaginal products including different formulations (tablets, rings, capsules, pessaries, creams, gels and ovules) and molecules (estradiol [E2], estriol [E3], promestriene, conjugated equine estrogens and estrone) have been used with superimposable therapeutic results. Low-dose and ultra-low-dose LET is the gold standard due to its minimal systemic absorption, with circulating E2 levels persistently remaining in the postmenopausal range. In healthy postmenopausal women, preference among the various products is presently the main driver and dissatisfaction with LET seems high, namely because of the delayed use in those with severe symptoms of genitourinary syndrome of menopause (GSM). Specific concerns remain in high-risk populations such as breast cancer survivors (BCS), especially those under treatment with aromatase inhibitors. Based on the multitude of symptoms under the umbrella of GSM definition, which includes vulvovaginal atrophy (VVA), it is mandatory to investigate specific effects of LET on quality of life, sexual function and genitourinary conditions by conducting studies with a patient-tailored focus.

摘要

局部雌激素治疗（LET）是治疗阴道干燥、性交困难和其他泌尿生殖系统症状的主要药物, 因为它可能逆转与内分泌功能下降和衰老有关的一些病理生理机制。多年来, 几种阴道产品, 包括不同的配方（片剂、环、胶囊、子宫托、乳膏、凝胶和胚珠）和分子（雌二醇[E2]、雌三醇[E3]、异丙炔、结合的马雌激素和雌酮）, 已被用于叠加的治疗效果。低剂量和超低剂量LET是金标准, 因为其全身吸收最小, 循环E2水平持续保持在绝经后范围内。在健康的绝经后妇女中, 目前对各种产品的偏好是主要驱动因素, 对LET的不满似乎很高, 即因为那些有严重更年期泌尿生殖系统综合征（GSM）症状的妇女延迟使用LET。特别是那些正在接受芳香化酶抑制剂治疗的高危人群, 如乳腺癌症幸存者（BCS）, 仍然存在特殊的担忧。基于GSM定义下的多种症状, 包括外阴阴道萎缩（VVA）, 必须通过对患者进行专门研究来研究LET对生活质量、性功能和泌尿生殖系统状况的具体影响。

Keywords:

• Local estrogen therapy
• estradiol
• estriol
• promestriene
• efficacy
• safety
• genitourinary syndrome of menopause
• vulvovaginal atrophy
• breast cancer survivors

Potential conflict of interest

R. E. Nappi had past financial relationships (lecturer, member of advisory boards and/or consultant) with Boehringer Ingelheim, Ely Lilly, Endoceutics, Merck Sharpe & Dohme, Palatin Technologies, Pfizer Inc., Procter & Gamble Co., TEVA Women’s Health Inc. and Zambon SpA; at present, she has an ongoing relationship with Abbott, Astellas, Bayer HealthCare AG, Exceltis, Fidia, Gedeon Richter, HRA Pharma, Novo Nordisk, Organon & Co., Shionogi Limited, Theramex and Viatris, outside the submitted work. The other authors report no conflicts of interest in this work.

Source of funding

Nil.