Management of postmenopausal vulvovaginal atrophy: recommendations of the International Society for the Study of Vulvovaginal Disease

Pérez‐López, Faustino R.; Phillips, Nancy; Vieira‐Baptista, Pedro; Cohen-Sacher, Bina; Fialho, Susana Cristina Aidé Viviani; Stockdale, Colleen K.

doi:10.1080/09513590.2021.1943346

Cited by 30 publications

(30 citation statements)

References 72 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The clinically relevant efficacy of vaginal estriol regarding the relief of subjective symptoms and objective findings compared to placebo or other vaginal estrogen preparations, has been sustained in several studies [ 21 – 23 ], reviews [ 24 , 25 ] and meta-analyses [ 26 ]. In addition, the reference estriol product chosen in this study has been approved for the therapy of vulvovaginal atrophy symptoms due to estrogen deficiency for more than 25 years in Germany.…”

Section: Discussionmentioning

confidence: 99%

Vaginal hormone-free moisturising cream is not inferior to an estriol cream for treating symptoms of vulvovaginal atrophy: Prospective, randomised study

et al. 2022

View full text Add to dashboard Cite

This prospective, open-label, multicentre, multinational, randomised trial investigated the non-inferiority of treatment with a vaginal hormone-free moisturising cream compared to a vaginal estriol (0.1%) cream in a panel of post-menopausal women suffering from symptoms of vulvovaginal dryness in a parallel group design. In total, 172 post-menopausal women were randomly allocated to either one of the two treatments, each administered for 43 days. The primary endpoint was the total severity score of subjective symptoms (dryness, itching, burning and pain unrelated to sexual intercourse) of the respective treatment period. Secondary endpoints were severity of single subjective symptoms (including dyspareunia if sexually active), impairment of daily life, Vaginal Health Index, as well as assessment of safety. In both groups, women treated with hormone-free moisturising cream and those treated with estriol cream, total severity score improved significantly compared to baseline by 5.0 (from 6.1 to 1.1) and by 5.4 (from 6.0 to 0.6), respectively, after 43 days of treatment (p < 0.0001). One-sided test of baseline differences (for a clinically relevant difference Δ = 1.5) confirmed the hormone-free moisturising cream to be non-inferior to the estriol cream. Severity of dyspareunia as well as impairment of daily life due to subjective symptoms, significantly improved for both treatment groups (p<0.0001). Subgroup analysis of women with mild or moderate impairment of daily life at baseline caused by “vaginal dryness” symptoms benefited from both creams, while women with severe impairment showed a significantly greater benefit from the estriol cream (p = 0.0032). Both treatments were well tolerated with no serious adverse events occurring. This study provides clinical evidence that a hormone-free vaginal moisturising cream cannot only improve vaginal dryness compared to an 0.1% estriol cream but also can relieve dyspareunia as well as improve woman’s impairment of daily life, justifying its use as a first choice for mild or moderate vulvovaginal dryness symptoms.

show abstract

Section: Discussionmentioning

confidence: 99%

Vaginal hormone-free moisturising cream is not inferior to an estriol cream for treating symptoms of vulvovaginal atrophy: Prospective, randomised study

et al. 2022

View full text Add to dashboard Cite

show abstract

“…The α receptors being present principally in the epithelium, the stroma, and the muscle fibers, while β receptors predominate in the blood vessel endothelium. Besides, androgen receptors also are present in the epithelium and the stroma of the vagina (32)(33)(34).…”

Section: Genital Symptomsmentioning

confidence: 99%

Genitourinary Syndrome of Menopause: Epidemiology, Physiopathology, Clinical Manifestation and Diagnostic

Sarmento

Costa

Vieira‐Baptista

et al. 2021

Front. Reprod. Health

Self Cite

View full text Add to dashboard Cite

Genitourinary syndrome of menopause (GSM) is a term used to define a compilation of signs and symptoms arising from decreased estrogenic stimulation of the vulvovaginal and lower urinary tract. Among 27–84% of women in postmenopausal are affected for symptoms of GSM, and these can unquestionably impair health, sexual function, consequently the quality of life of these women. The main signs and symptoms of GSM include, among others, burning, irritation, vulvovaginal dryness, dyspareunia, urinary symptoms of urgency, dysuria, or recurrent urinary tract infection. The diagnosis can be made through anamnesis, questionnaires, physical exams, and, sometimes, complementary exams. Objective vaginal assessment is essential and can be complemented by using the Vaginal Health Index (VHI), Vaginal Maturation Index (VMI), or vaginal pH measurement. The acknowledgment of this condition by health professionals is crucial for its identification and proper management and exclusion of other conditions that make a differential diagnosis with it.

show abstract

“…Low-dose vaginal ET is the most used pharmacological treatment for VVA, being also the most effective and safer option. During the low-dose vaginal ET use, systemic estrogen absorption is minimal, and serum estradiol remains within postmenopausal levels (7)(8)(9)(10)(11)(12)(13)(14).…”

Section: Local (Vaginal)mentioning

confidence: 99%

“…The use of a progestogen is not required for endometrial protection in women receiving low-dose vaginal ET. Nonetheless, periodic endometrial surveillance or progestogen use can be considered for women at high-risk endometrial neoplasia (7)(8)(9)(10)(11)(12)(13)(14).…”

Section: Local (Vaginal)mentioning

confidence: 99%

“…Another complication that usually not requires treatment is the development of mild transient candidiasis (19). Vaginal ET does not seem to increase the risk of venous thromboembolism, but data on high-risk patients are lacking (7)(8)(9)(10)(11)(12)(13)(14). Essentially, non-hormonal treatments are preferred initial strategies for the survivors of hormone-dependent cancers (breast and endometrial cancers).…”

Section: Local (Vaginal)mentioning

confidence: 99%

See 1 more Smart Citation

Hormonal Approach for Postmenopausal Vulvovaginal Atrophy

Costa

Sarmento

Vieira‐Baptista

et al. 2021

Front. Reprod. Health

Self Cite

View full text Add to dashboard Cite

Menopause is a physiological and progressive phenomenon secondary to decreased ovarian follicular reserve that significantly affects the genital tract. Although postmenopausal vulvovaginal atrophy primarily affects postmenopausal women, it is also seen in premenopausal women. The hypoestrogenic condition results in hormonal and anatomical changes, with the main symptoms, are dryness, burning and genital irritation, decreased lubrication, urinary urgency, dysuria, and recurrent urinary tract infections. This review aims to update hormone therapy for urogenital atrophy, both local and systemic, and discusses the importance of understanding and the need for active treatment of this condition. The main therapeutic objective is the relief of symptoms, and hormonal therapy (HT) is still the most effective choice for treating clinical manifestations, despite the side effects of its use. HT should be used in an individualized way to the needs of the women and appropriate to the stage in which she is menopausal, perimenopausal, or after menopause.

show abstract

Management of postmenopausal vulvovaginal atrophy: recommendations of the International Society for the Study of Vulvovaginal Disease

Cited by 30 publications

References 72 publications

Vaginal hormone-free moisturising cream is not inferior to an estriol cream for treating symptoms of vulvovaginal atrophy: Prospective, randomised study

Vaginal hormone-free moisturising cream is not inferior to an estriol cream for treating symptoms of vulvovaginal atrophy: Prospective, randomised study

Genitourinary Syndrome of Menopause: Epidemiology, Physiopathology, Clinical Manifestation and Diagnostic

Hormonal Approach for Postmenopausal Vulvovaginal Atrophy

Contact Info

Product

Resources

About