What should guide our patient management of vulvovaginal atrophy?

Abstract

Genitourinary syndrome of menopause including vulvovaginal atrophy is commonly experienced by postmenopausal women, reducing their quality of life. The aim of this review is to assess current treatment options within the framework of recent management guidelines. Recommendations include use of treatments addressing both symptoms and the underlying pathophysiology, and proactive patient discussion. Both prescription and non-prescription options are recognized, including non-hormone-based approaches. Local therapy is preferable in the primary treatment of genitourinary syndrome of menopause symptoms as risk of adverse events is reduced, although long-term safety data are limited. Management of patients with a history of breast cancer requires careful consideration, although estrogen therapy has not been associated with increased risk of breast cancer or of recurrence. Treatment should consider ongoing cancer therapy. As multiple, comparable options exist, treatment choice may be due to experience and patient preference. Best management requires effective patient–physician communication and shared decision-making.

Chinese abstract

很多绝经后女性经历着包括外阴阴道萎缩在内的更年期泌尿生殖综合征, 这些疾病降低了她们的生活质量。本综述的目的是基于最近的管理指南评估目前的治疗方案。推荐的治疗规范包括与患者进行积极的讨论, 使用能够缓解症状的病理生理学的治疗方法。可以使用处方药和非处方药, 包括非激素类药物。尽管缺乏长期的安全性数据, 更年期泌尿生殖综合征的初级治疗, 仍然首选局部治疗, 因为其不良事件发生的风险较低。虽然雌激素治疗与乳腺癌复发风险增加无关, 对有乳腺癌病史的患者仍然需要谨慎管理, 治疗方案的选择应兼顾到正在进行的癌症治疗。由于存在多种类似的选择, 选择治疗方法时, 可以是基于经验或患者的偏好。最佳的治疗效果需要有效的医 - 患沟通以及共同决策。

Keywords:

• Genitourinary syndrome of menopause
• vulvovaginal atrophy
• menopause-associated estrogen reduction

Conflict of interest

Speaking Bureaus: AMAG, MITHRA, NovoNordisk, TherapeuticsMD, Pfizer, Merck.

Source of funding

Editorial support supplied by Bonnie Kuehl and Brittany Carsons, Scientific Insights Consulting Group Inc.

Additional information

Funding

Editorial support supplied by Bonnie Kuehl and Brittany Carsons, Scientific Insights Consulting Group Inc.