Current challenges in the pharmacological management of genitourinary syndrome of menopause

ABSTRACT

Introduction

Genitourinary syndrome of menopause is caused by climacteric estrogens drop and leads to bothersome and progressive genital and urinary symptoms. Considering the high frequency in the population and the impact on quality of life, it is crucial to find a safe and effective treatment. Pharmacological therapies aim to modulate the hormonal system and reverse tissue changes due to hypoestrogenism and consequently the symptoms.

Areas covered

We analyzed the scientific evidence concerning the main pharmacological treatments, which include systemic and topical estrogens, prasterone and ospemifene. This literature review focused on recent safety and efficacy findings in an attempt to identify the best treatment choice for each individual patient.

Expert opinion

There are encouraging data regarding the efficacy of all currently available pharmacological options and concerning their short and long-term safety. There are still doubts regarding best treatment choice for oncological high-risk population, in particular for breast cancer survivors, and some issues relative to patients’ poor compliance and treatment adherence. For these reasons further studies need to be conducted with a patient-tailored focus.

KEYWORDS:

• Menopause
• genitourinary syndrome menopause
• vaginal atrophy
• breast cancer
• hormone replacement therapy
• DHEA
• ospemifene
• GSM

Article highlights

• Genitourinary syndrome of menopause (GSM) is a chronic progressive condition that involves genitals and lower urinary tract, caused by the drop-in estrogens level due to menopausal onset. GSM has an incredibly high frequency in general population and heavily affects women’s quality of life.

• Treatment includes pharmacological therapies that influence the hormonal system in order to revert the menopausal tissue degeneration and consequently improve the symptoms. Pharmacological options include systemic and local estrogens, prasterone and ospemifene.

• While systemic hormonal replacement therapy is effective but not recommended for isolated GSM, topical estrogens found to be useful in genital symptoms relief and safe regarding oncological risk and predisposition to thromboembolic events.

• Prasterone and Ospemifene demonstrated efficacy in improving GSM symptoms such as vaginal dryness and dyspareunia, but there is no evidence on their safety in patients with a prior history or increased risk of breast cancer and further studies are needed on this field.

• Despite all the literature available, the most difficult challenge is to find the best therapeutic option for each single patient. The choice of the most effective and safety pharmacological treatment remains very arduous and need to take into account efficacy, safety, side effects, patient’s preference and ability to adhere to the prescribed therapy.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.