Efficacy of Hormonal and Nonhormonal Approaches to Vaginal Atrophy and Sexual Dysfunctions in Postmenopausal Women: A Systematic Review

Abstract

Objective To evaluate the efficacy of the hormonal and nonhormonal approaches to symptoms of sexual dysfunction and vaginal atrophy in postmenopausal women. Data Sources We conducted a search on the PubMed, Embase, Scopus, Web of Science, SciELO, the Cochrane Central Register of Controlled Trials (CENTRAL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, as well as on clinical trial databases. We analyzed studies published between 1996 and May 30, 2020. No language restrictions were applied. Selection of Studies We selected randomized clinical trials that evaluated the treatment of sexual dysfunction in postmenopausal women. Data Collection Three authors (ACAS, APFC, and JL) reviewed each article based on its title and abstract. Relevant data were subsequently taken from the full-text article. Any discrepancies during the review were resolved by consensus between all the listed authors. Data Synthesis A total of 55 studies were included in the systematic review. The approaches tested to treat sexual dysfunction were as follows: lubricants and moisturizers (18 studies); phytoestrogens (14 studies); dehydroepiandrosterone (DHEA; 8 studies); ospemifene (5 studies); vaginal testosterone (4 studies); pelvic floor muscle exercises (2 studies); oxytocin (2 studies); vaginal CO2 laser (2 studies); lidocaine (1 study); and vitamin E vaginal suppository (1 study). Conclusion We identified literature that lacks coherence in terms of the proposed treatments and selected outcome measures. Despite the great diversity in treatment modalities and outcome measures, the present systematic review can shed light on potential targets for the treatment, which is deemed necessary for sexual dysfunction, assuming that most randomized trials were evaluated with a low risk of bias according to the Cochrane Collaboration risk of bias tool. The present review is registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42018100488).

The Concept behind the Suitability of Menstrual Blood-Derived Stem Cells for the Management of Vaginal Atrophy among BRCA Mutation Carriers after RRSO

“…The most reported sexual symptom is vaginal dryness (more than 50%), followed by dyspareunia and reduced libido, which are considered the strongest predictors of discontent concerning the decision to undergo RRSO. It was also reported that premenopausal women undergoing riskreducing surgery experience a greater decline in sexual function than post-menopausal women [20,21].…”

A eficácia do laser de Co2 no tratamento da Síndrome Geniturinária na menopausa – uma revisão bibliográfica

“…Lubrificantes e hidratantes de longa duração podem ajudar a aliviar os sintomas quando necessário, porém não tratam a condição atrófica da região em questão. Estes apresentam um menor impacto do que os estrogênios (Sarmento et al, 2022).…”

Effectiveness and Safety of Hormonal Therapy in Improving Sexual Function in Women in Menopause

“…Hormone replacement therapy is often considered the most effective treatment for alleviating vasomotor symptoms and sexual changes in menopausal women. However, there is a portion of women who cannot benefit from this treatment, and although the true effectiveness of other methods is still not fully understood, some of them have shown improvements in symptoms with mild to moderate adverse effects, without serious ones (SARMENTO et al, 2023).…”

“…When started late, hormone therapy has a negative effect on cognitive function, increasing the risk of Alzheimer's (METHA et al, 2021). For women who have contraindications, especially those with firstdegree relatives with a history of breast cancer, other treatment options may be considered, such as the use of vaginal lubricants and moisturizers, phytoestrogens, ospemifene, pelvic floor muscle exercises, oxytocin, CO2 laser in the vaginal region, lidocaine, and vitamin E vaginally (SARMENTO et al, 2023).…”