Genitourinary Syndrome of Menopause: Current Treatment Options in Breast Cancer Survivors – Systematic Review

Mensión, Eduard; Alonso, I.; Castelo-Branco, Camil

doi:10.1016/j.maturitas.2020.08.010

Cited by 32 publications

(39 citation statements)

References 47 publications

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“…According to international guidelines, nonhormonal therapies are the first-line treatment for mild-moderate VVA in both healthy women and BCSs[ 113 ]. According to a systematic review carried out this year (2021) by Mension et al [ 114 ] about current treatment options for genitourinary syndrome of menopause in BCSs, there are 10 studies related to nonhormonal options (excluding laser therapy) (4 prospective studies and 6 randomized controlled trials (RCTs)) (Table 1 ).…”

Section: Current Treatment Options For Genitourinary Syndrome Of Meno...mentioning

confidence: 99%

“…Although there is limited data to support the efficacy of over-the-counter products[ 113 , 114 ], vaginal moisturizers and lubricants are considered the initial and mainstay treatment options for GSM in women with breast cancer[ 40 ], and they are widely used[ 18 ], particularly for women with mild symptoms and those who want to avoid local estrogens[ 18 , 40 ]. However, these products are poorly differentiated and characterized[ 112 ].…”

Section: Current Treatment Options For Genitourinary Syndrome Of Meno...mentioning

confidence: 99%

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Management of genitourinary syndrome of menopause in breast cancer survivors: An update

López¹

2022

WJCO

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There is increasing attention about managing the adverse effects of adjuvant therapy (Chemotherapy and anti-estrogen treatment) for breast cancer survivors (BCSs). Vulvovaginal atrophy (VVA), caused by decreased levels of circulating estrogen to urogenital receptors, is commonly experienced by this patients. Women receiving antiestrogen therapy, specifically aromatase inhibitors, often suffer from vaginal dryness, itching, irritation, dyspareunia, and dysuria, collectively known as genitourinary syndrome of menopause (GSM), that it can in turn lead to pain, discomfort, impairment of sexual function and negatively impact on multiple domains of quality of life (QoL). The worsening of QoL in these patients due to GSM symptoms can lead to discontinuation of hormone adjuvant therapies and therefore must be addressed properly. The diagnosis of VVA is confirmed through patient-reported symptoms and gynecological examination of external structures, introitus, and vaginal mucosa. Systemic estrogen treatment is contraindicated in BCSs. In these patients, GSM may be prevented, reduced and managed in most cases but this requires early recognition and appropriate treatment, but it is normally undertreated by oncologists because of fear of cancer recurrence, specifically when considering treatment with vaginal estrogen therapy (VET) because of unknown levels of systemic absorption of estradiol. Lifestyle modifications and nonhormonal treatments (vaginal moisturizers, lubricants, and gels) are the first-line treatment for GSM both in healthy women as BCSs, but when these are not effective for symptom relief, other options can be considered, such as VET, ospemifene, local androgens, intravaginal dehydroepiandrosterone (prasterone), or laser therapy (erbium or CO2 Laser). The present data suggest that these therapies are effective for VVA in BCSs; however, safety remains controversial and a there is a major concern with all of these treatments. We review current evidence for various nonpharmacologic and pharmacologic therapeutic modalities for GSM in BCSs and highlight the substantial gaps in the evidence for safe and effective therapies and the need for future research. We include recommendations for an approach to the management of GSM in women at high risk for breast cancer, women with estrogen-receptor positive breast cancers, women with triple-negative breast cancers, and women with metastatic disease.

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Section: Current Treatment Options For Genitourinary Syndrome Of Meno...mentioning

confidence: 99%

Section: Current Treatment Options For Genitourinary Syndrome Of Meno...mentioning

confidence: 99%

Management of genitourinary syndrome of menopause in breast cancer survivors: An update

López¹

2022

WJCO

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“…There is need for caution in drug intake during pregnancy, so as to avoid fetal malformation and other congenital diseases. Therefore, the health of pregnant women and their fetuses should be considered comprehensively in the treatment of vaginitis [4][5][6]. In addition, some pregnant women may ignore the importance of timely treatment of vaginitis.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of combination of nifuratel tablets with Baofukang suppository on treatment and recurrence of vaginitis in pregnancy

Wang¹,

Zhang²

2022

Trop. J. Pharm Res

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Purpose: To investigate the effect and safety of a combination of Nifuratel tablets and Baofukang suppository in the treatment and recurrence of vaginitis in pregnant patients. Methods: A retrospective analysis was carried out on 100 in-patients admitted between February 2019 and April 2020. They were randomly assigned to control and study groups, with 50 in each group. The control group received Baofukang suppository treatment, whilst the study group was treated with Nifuratel tablets in addition to Baofukang suppository. The two groups were compared with regard to treatment effectiveness, incidence of adverse reactions, recurrence at 1, 2 and 3 months post-treatment; time taken for disappearance of clinical symptoms, and levels of inflammatory factors 1 week after treatment. Moreover, Mental Status Scale in Non-Psychiatric Settings (MSSNS) score, and Quality of Life Index (QLI) score were compared between the groups. Results: The study group out-performed the control group with respect to treatment effectiveness and QLI score (p < 0.05). Patients in the study group had significantly lower incidence of adverse reactions, degree of recurrence at 1, 2 and 3 months post-treatment, time taken for disappearance of clinical symptoms, expression levels of inflammatory factors, and MSSNS score, when compared to those in control group (p < 0.05). Conclusion: Combined use of Nifuratel tablets and Baofukang suppository in the treatment of pregnant patients with vaginitis leads to significant treatment efficacy and safety, and reduced recurrence and expression levels of inflammatory factors in patients.

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“…Lately, new therapeutic options are being considered to treat GSM symptoms, such as vaginal laser, ospemifene, or prasterone, potential alternatives for those patients where estrogenic therapies are not recommended. [ 3 ]…”

Section: Introductionmentioning

confidence: 99%

Genitourinary Syndrome of Menopause Assessment Tools

Mensión¹,

Alonso²,

Tortajada³

et al. 2021

Journal of Mid-Life Health

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New therapeutic options are being considered to treat genitourinary syndrome of menopause (GSM), such as vaginal laser, ospemifene, or prasterone, but there is no explicit agreement in the scientific community for its use. Some concerns have arisen on how to evaluate the improvement of GSM symptoms. In 2003, the FDA suggested possible end points for this purpose: change in severity of symptoms, change in vaginal pH, and change in vaginal maturation index (VMI). Contrarily, the most common assessment tools used to quantify severity and improvement of GSM nowadays are the visual analog scale of GSM symptoms, the vaginal health index, and the female sexual function index. In our opinion, subjective and objective variables to evaluate GSM can be differentiated, and not many of the considered objective outcomes are used in the recent literature assessing GSM. There is the possibility that some therapies present only subjective improvement, giving place to a possible placebo effect that is not being evaluated. To conclude, there is a demand to evaluate whether vaginal pH and VMI are enough to assess objectively GSM changes or new objective approaches should be audited.

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Genitourinary Syndrome of Menopause: Current Treatment Options in Breast Cancer Survivors – Systematic Review

Cited by 32 publications

References 47 publications

Management of genitourinary syndrome of menopause in breast cancer survivors: An update

Management of genitourinary syndrome of menopause in breast cancer survivors: An update

Efficacy and safety of combination of nifuratel tablets with Baofukang suppository on treatment and recurrence of vaginitis in pregnancy

Genitourinary Syndrome of Menopause Assessment Tools

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