Vulvovaginal atrophy in women after cancer

Abstract

The number of women surviving longer after a cancer diagnosis is increasing. This means that more awareness regarding their health is required. This review will focus on vulvovaginal atrophy (VVA)/genitourinary syndrome of menopause, one of the most distressing adverse iatrogenic effects of the menopause, secondary to cancer therapies. The cancer therapies themselves, such as radiotherapy, chemotherapy, and surgery, have a direct impact on the lower genital tract which interplays with the ensuing hypoestrogenic state of the menopause. Symptoms of VVA are still under-reported and undertreated as neither clinicians nor patients are forthcoming in discussing the problem, despite its profound negative impact on quality of life. In terms of treatment of VVA, this review will look at the use of various options, including estrogen post cancer diagnosis, as well as considering newer emerging therapies such as dehydroepiandrosterone, ospemifene, and laser. The care of a woman post cancer diagnosis should be a multidisciplinary responsibility. However, further research is required into emerging treatment options as well as long-term safety data, to ensure all health-care providers and women are fully informed and confident to effectively address the impact of VVA post cancer diagnosis.

摘要

癌症诊断后越来越多的女性存活时间更长。这意味着需要更多有关她们健康的信息。这篇综述将集中在绝经期外阴阴道萎缩（VVA）/泌尿生殖系统综合征, 这是继癌症治疗之后出现的绝经期最令人困扰的医源性不良影响之一。癌症治疗本身, 如放疗、化疗和外科手术, 对下生殖道具有直接影响, 下生殖道与随之而来的绝经低雌激素状态相互作用。尽管VVA的症状对生活质量产生了深远的负面影响, 但临床医生和患者都没有讨论这个问题, 因此VVA的症状仍未得到充分关注和治疗。在VVA的治疗方面, 本综述将探讨各种方法的采用, 包括癌症诊断后的雌激素, 以及考虑采用新兴疗法, 例如脱氢表雄酮、奥培米芬和激光。癌症诊断后的女性护理应该是多学科的责任。但是, 需要对新兴的治疗方案以及长期安全性数据进行进一步研究, 以确保所有医护人员和女性患者都充分了解情况并充满信心, 可以有效应对癌症诊断后VVA的影响。

Keywords:

• Cancer
• vulvovaginal atrophy
• genitourinary syndrome of menopause
• estrogen
• iatrogenic menopause

Potential conflict of interest

Patricia Cox has no declarations of interest. Nick Panay has lectured and acted in an advisory capacity for a number of companies, including Abbott, Bayer, Besins, Consilient, Glenmark, Fotona, Meda, Mithra, MSD, Mylan, Novo Nordisk, Pfizer, SeCur, Shionogi, and Theramex.

Additional information

Funding

Nick Panay has/will be receiving funding for research from Abbott, Gedeon Richter, Mylan, NeRRe/Pharm Olam, and the Yes company.