Managing vulvovaginal atrophy after breast cancer

Sassarini, Jenifer; Perera, Mahesh; Spowart, Keith; McAllister, Kay; Fraser, Judith; Glasspool, Ros; Harrand, Rosie; Chitoni, Marina; Stallard, Sheila; Lumsden, Mary-Ann

doi:10.1177/2053369118805344

Cited by 8 publications

(5 citation statements)

References 8 publications

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“…The results of Delphi Panel were able to shed some light on the Italian situation and to confirm that also in Italy, VVA, especially in BC patients, is a socially relevant condition. The results appear in line with several very recent papers that emphasize the importance of VVA in general [3,4,[18][19][20] and in BC patients [21] and confirm that the condition still represents an unmet medical need [22].…”

Section: Discussionsupporting

confidence: 90%

Vulvovaginal atrophy (VVA) in breast cancer survivors (BCS) is still an unmet medical need: results of an Italian Delphi Panel

Biglia¹,

Pup

Masetti

et al. 2020

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Purpose VVA is a common disease, with approximately 50% of all postmenopausal women having related symptoms. VVA has a significant impact on the personal and sexual lives and on many aspects of women's self-esteem and emotional well-being. It is particularly frequent and severe in patients treated for BC, where it originates significant economic and social costs. Given the lack of published evidence on this subject, a Delphi Panel was carried out to evaluate: & The epidemiology of VVA and of its risk-factors/comorbidities in Italy & The present standard of care and unmet medical needs & The comparison between recent US epidemiological data and the Italian situation & The health resources used in VVA BC The burden of illnessDespite the considerable negative impact on quality of life, a disparity between the high prevalence of this condition and the infrequent clinical diagnosis is documented in medical practice and in surveys. This inaccuracy is thought to be primarily a consequence of patients' unwillingness and/or reluctance to report symptoms in the clinical setting and of health-care professional's difficulty in approaching this sensitive topic during routine consultations.

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Section: Discussionsupporting

confidence: 90%

Vulvovaginal atrophy (VVA) in breast cancer survivors (BCS) is still an unmet medical need: results of an Italian Delphi Panel

Biglia¹,

Pup

Masetti

et al. 2020

Support Care Cancer

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“…57 Other causes include breast feeding as high levels of prolactin antagonise the production of estrogen, 58 use of depot medroxyprogesterone acetate for contraception, 59 Gonadotrophin releasing hormone analogues (GnRH) analogues which inhibit the hypothalamo–pituitary–ovarian axis, diabetes due to peripheral neuropathy and microvascular disease 60 and side effects of cancer treatments associated with ovarian suppression or failure, particularly breast cancer treatments. 61–66 It is not clear why some post-menopausal women are affected, and others are not, irrespective of use of systemic Hormone replacement therapy (HRT). Continuing sexual activity may prevent progression of tissue changes, ‘the use it or lose it’ theory.…”

Section: Methodsmentioning

confidence: 99%

Urogenital atrophy: The ‘unknown factors’ challenging current practice

Briggs

Hapangama

2021

Post Reprod Health

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Urogenital atrophy occurs as a result of the effect of estrogen deficiency on the tissue quality in the vulva, vagina, urethra and bladder. It is a common consequence of the menopause, with possibly up to 80% of women experiencing symptoms. Despite a number of different diagnostic methods, there is no validated objective method by which to confirm the diagnosis in clinical practice and research settings. Education, for women and clinicians, is called for to support diagnosis and treatment. However, before this can be of global benefit, development of an accessible and reproducible diagnostic test is required. Current assessment methods include routine history and clinical examination, with the clinician’s opinion based on their subjective observations. A vaginal smear to assess the ratio of superficial to parabasal cells and measurement of the pH of the vaginal secretions is more commonly used in research settings. A number of formulae have been postulated to facilitate the diagnosis including the Vaginal Health Index, the Vulval Health Index, the Genitourinary Syndrome of the Menopause assessment tool, the Genital Health Clinical Evaluation and vaginal biopsy and assessment of the vaginal microbiome. However, none of these potential methods of assessment has been validated. This article focuses on what we do not know about urogenital atrophy including the prevalence, the most appropriate terminology, aetiology, pathogenesis and the most objective and reproducible method of assessment.

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“…First-line therapies for GSM include non-hormonal, long-acting vaginal moisturizers and low-dose vaginal estrogens [ 61 , 62 , 63 , 64 ]. According to the last position statement of North American Menopause Society [ 61 ] and expert reviews [ 11 , 65 , 66 ], non-hormonal treatments should be considered the first line therapy for patients with BC or hormone-dependent tumors. In addition to the use of vaginal moisturizers and lubricants, regular use of vaginal dilators as well as pelvic floor therapy has been recommended for symptomatic vaginal atrophy to reduce pain with vaginal penetration [ 11 ].…”

Section: Gsm Managementmentioning

confidence: 99%

Hyaluronic Acid: A Valid Therapeutic Option for Early Management of Genitourinary Syndrome of Menopause in Cancer Survivors?

et al. 2022

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Genitourinary syndrome of menopause (GSM) is a chronic condition affecting a large number of women, with a major impact on their urogenital health and sexual function. It occurs at midlife because estrogen levels decline with menopause enhancing aging-related changes of the functional anatomy of the urogenital system. Unfortunately, GSM may occur early in the lifespan of women or be exacerbated following anticancer treatments, such as chemotherapy, ionizing radiation, or surgical removal of reproductive organs. Symptoms of GSM are often under-reported by women, under-estimated and under-diagnosed by health care providers (HCPs), and subsequently under-treated, despite their profound negative impact on the quality of life. The mainstay of vaginal treatments is local estrogen therapy (LET) ensuring an effective management of moderate to severe symptomatic GSM. However, LET is generally contraindicated in women with a history of hormone receptor positive cancer, due to the fear of increased recurrence or possible interference with endocrine adjuvant therapies. Among non-hormonal treatments, hyaluronic acid-based moisturizers have shown promising clinical results both in healthy women and in cancer patients or survivors. Its strong water-binding properties provide lubricating and moisturizing effects, which contribute to maintaining a proper level of hydration and viscoelasticity in several body parts, including the urinary tract and genital tissues. Hyaluronic acid-based moisturizers are effective, safe, and well tolerated; therefore, they may represent a valid option for the early management of GSM-associated symptoms in every woman with a history of cancer who is unable or unwilling to undergo hormone-based therapies. Hence, the aim of this review was to provide an overview of GSM etiology and treatment in women with natural or iatrogenic menopause, with a focus on the use of hyaluronic acid as a prophylactic treatment in the context of an integrated management protocol for cancer patients.

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Managing vulvovaginal atrophy after breast cancer

Cited by 8 publications

References 8 publications

Vulvovaginal atrophy (VVA) in breast cancer survivors (BCS) is still an unmet medical need: results of an Italian Delphi Panel

Vulvovaginal atrophy (VVA) in breast cancer survivors (BCS) is still an unmet medical need: results of an Italian Delphi Panel

Urogenital atrophy: The ‘unknown factors’ challenging current practice

Hyaluronic Acid: A Valid Therapeutic Option for Early Management of Genitourinary Syndrome of Menopause in Cancer Survivors?

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