Genitourinary Syndrome of Menopause in Breast Cancer Survivors: Are We Facing New and Safe Hopes?

Biglia, Nicoletta; Bounous, Valentina Elisabetta; Sgrò, Luca; D’Alonzo, Marta; Pecchio, Silvia; Nappi, Rossella E.

doi:10.1016/j.clbc.2015.06.005

Cited by 62 publications

(40 citation statements)

References 79 publications

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“…It has been reported that fractional CO 2 laser stimulates the production of new collagen and elastic fibers [Biglia et al 2015], alleviating symptoms of vaginal dryness, burning, itching, dyspareunia and dysuria, resulting in improved sexual function and satisfaction with sexual life [Salvatore et al 2014;Salvatore et al 2015;Lee, 2014]. Nonetheless, available data are shortterm and efficacy and safety of repeated applications is not clear [Hutchinson-Colas and Segal, 2015], nor are there published clinical trials in women with breast cancer.…”

Section: Lasermentioning

confidence: 99%

A clinical guide to the management of genitourinary symptoms in breast cancer survivors on endocrine therapy

et al. 2017

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There is increasing attention and concern about managing the adverse effects of adjuvant endocrine therapy for women with early breast cancer as the side effects of therapy influence compliance and can impair quality of life (QoL). Most side effects associated with tamoxifen (TAM) and aromatase inhibitors (AIs) are directly related to estrogen deprivation, and the symptoms are similar to those experienced during natural menopause but appear to be more severe than that seen in the general population. Prolonged estrogen deprivation may lead to atrophy of the vulva, vagina, lower urinary tract and supporting pelvic structures, resulting in a range of genitourinary symptoms that can in turn lead to pain, discomfort, impairment of sexual function and negatively impact on multiple domains of QoL. The genitourinary side effects may be prevented, reduced and managed in most cases but this requires early recognition and appropriate treatment. We provide an overview of practical clinical approaches to understanding the pathophysiology and the management of genitourinary symptoms in postmenopausal women receiving adjuvant endocrine therapy for breast cancer.

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Section: Lasermentioning

confidence: 99%

A clinical guide to the management of genitourinary symptoms in breast cancer survivors on endocrine therapy

et al. 2017

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“…After a single session with 10,600 nm fractional ablative CO 2 laser, histological sampling was obtained, which revealed vaginal mucosa approximating a premenopausal state, including a thickened epidermis, increased glycogen, and enhanced dermal vasculature . Ablative‐pulsed CO 2 lasers have been studied in the treatment of VVA, which includes symptoms of itching, burning, reduced lubrication, and dyspareunia .…”

Section: Discussionmentioning

confidence: 99%

Lasers and energy‐based devices marketed for vaginal rejuvenation: A cross‐sectional analysis of the MAUDE database

2019

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Introduction:The FDA issued a statement on July 30, 2018, expressing concern over the marketing of lasers and energy-based devices to promote "vaginal rejuvenation." The FDA stated that there is insufficient data to recommend this modality for optimization of sexual function and alleviation of genitourinary syndrome of menopause (GSM)-related symptoms in postmenopausal or postpartum women. This analysis aims to characterize the mandatory and voluntary reports concerning laser and energy-based procedures marketed for vaginal rejuvenation. Methods: Cross-sectional analysis of the FDA database, Manufacturer and User Facility Device Experience (MAUDE), for events related to laser and energy-based devices for vaginal rejuvenation. Results: Between October 2015 and January 2019, 45 distinct events describing 46 patients were recorded and reviewed. The most commonly reported adverse event related to the procedure was pain (vulvar, bladder, urethral, or unspecified) (n ¼ 19). The majority of patients sought medical care for their injuries, which included evaluation by urgent care, urology, gynecology, neurology, gastroenterology, pelvic floor therapy, primary care providers, and the device operator. Thirtythree patients indicated chronicity of their injury, which included long-term pain, numbness, burning, bladder disturbances, infections, scarring, dyspareunia, worsening symptoms, aggravation of lichen sclerosis, and disfigurement. Conclusions: A variety of adverse events associated with the use of laser and energy-based devices for "vaginal rejuvenation" was reported to the MAUDE database. Although the circumstances surrounding these events were unclear, these reports signify the importance of clinical trials that investigate the efficacy and safety profile of laser and energy-based devices for optimization of sexual function and treatment of GSM-related symptoms. Lasers Surg. Med.

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“…Especial atención merecen las pacientes que padecen cáncer ginecológico estrógeno-dependiente (mama, ovario, endometrio), las cuales presentan un elevado riesgo de síntomas importantes de AVV y disfunción sexual, especialmente en mujeres jóvenes (113)(114)(115)(116)(117)(118)(119). La literatura ha demostrado un incremento en la incidencia y progresión de los síntomas genitourinarios consecuencia de la quimioterapia, radioterapia y de la terapia endocrina.…”

Section: Discussionunclassified

“…En general, para las pacientes con cáncer de mama E dependiente, son preferibles de inicio las terapias no hormonales, pero cuando éstas no son efectivas, pueden utilizarse E vaginales en la mínima dosis eficaz y tras el consentimiento de la paciente (16,42,116). Para este grupo de mujeres el tratamiento vaginal con láser de CO2 se plantea como una opción viable (117,118).…”

Section: Discussionunclassified

Tratamiento del síndrome genitourinario de la menopausia mediante láser fraccionado CO2: una opción terapéutica emergente

T¹,

G²,

J³

et al. 2016

Rev. chil. obstet. ginecol.

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RESUMENEstudios recientes han demostrado que el láser fraccionado es una opción terapéutica no hormonal efectiva, sencilla, bien tolerada y sin efectos adversos, para el tratamiento del Síndrome Genitourinario de la Menopausia. La reacción térmica originada produce la restauración del epitelio vaginal, un proceso de neocolagénesis y una mayor vascularización que favorece la llegada de nutrientes, reestableciéndose la estructura de la mucosa, su grosor y trofismo funcional, mejorando por tanto la sintomatología. No obstante, se precisan estudios a largo plazo, controlados, frente a estrógenos locales y otros tratamientos no hormonales para validar la duración de los efectos y la seguridad de las sucesivas aplicaciones. El objetivo de este trabajo es revisar la evidencia relacionada con esta terapia emergente. PALABRAS CLAVE: Láser, atrofia vaginal, síndrome genitourinario, menopausia SUMMARYRecent reported studies have demonstrated that non-invasive fractional laser is a valid, safe, effective and well tolerated therapeutic option, without adverse events to treat the Menopause Genitourinary Syndrome. The heat shock effect induces the increase of vaginal epithelium thickness, the new glycogen content and the vascular changes, improving the vaginal epithelium structure, functionality and menopausal symptoms. Nevertheless, duration of treatment effects and safety of repeated session are not clear enough. Further controlled long-term follow-up research on laser versus local estrogens and other non-hormonal therapies are needed. The objective of this paper is to review the scientific evidence related to this emergent treatment.

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Genitourinary Syndrome of Menopause in Breast Cancer Survivors: Are We Facing New and Safe Hopes?

Cited by 62 publications

References 79 publications

A clinical guide to the management of genitourinary symptoms in breast cancer survivors on endocrine therapy

A clinical guide to the management of genitourinary symptoms in breast cancer survivors on endocrine therapy

Lasers and energy‐based devices marketed for vaginal rejuvenation: A cross‐sectional analysis of the MAUDE database

Tratamiento del síndrome genitourinario de la menopausia mediante láser fraccionado CO2: una opción terapéutica emergente

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