Recommendations for the management of postmenopausal vaginal atrophy

Abstract

Unlike hot flushes and night sweats which resolve spontaneously in time, atrophic symptoms affecting the vagina and lower urinary tract are often progressive and frequently require treatment. The prevalence of vaginal dryness increases as a woman advances through the postmenopausal years, causing itching, burning and dyspareunia, and sexual activity is often compromised. But, despite the various safe and effective options, only a minority (about 25% in the Western world and probably considerably less in other areas) will seek medical help. Some of this reluctance is due to the adverse publicity for hormone replacement therapy (HRT) over recent years that has suggested an increased risk of breast cancer, heart disease and stroke. But, regardless of whether these scares are justified, local treatment of vaginal atrophy is not associated with these possible risks of systemic HRT. Other reasons for the continued suffering in silence may be cultural and an understandable reluctance to discuss such matters, particularly with a male doctor, but the medical profession must also take much of the blame for failing to enquire of all postmenopausal women about the possibility of vaginal atrophic symptoms. Vaginal dryness can be helped by simple lubricants but the best and most logical treatment for urogenital atrophy is to use local estrogen. This is safe, effective and with few contraindications. It is hoped that these guidelines and recommendations, produced to coincide with World Menopause Day 2010, will help to highlight this major cause of distress and reduced quality of life and will encourage women and their medical advisers all over the world to seek and provide help.

Láser erbium vaginal como tratamiento del síndrome genitourinario de la menopausia: resultados preliminares

“…El SGM puede afectar hasta el 50% de las mujeres posmenopáusicas, sus síntomas tienden a ser crónicos y progresivos (2)(3)(4)(5)(6)(7)(8), afectando la sexualidad y la calidad de vida (9)(10)(11)(12)(13)(14)(15). Algunas preparaciones, incluidos lubricantes y humectantes mejoran los sínto-mas, sin embargo proporcionan un alivio temporal.…”

“…La terapia de reemplazo hormonal (TRH) puede proporcionar un alivio rápido y a largo plazo (16). La administración de estrógenos vaginales locales es el tratamiento de elección (2,3). Aunque no han sido identificados riesgos sistémicos con estróge-nos locales de baja dosis, los datos de eficacia y seguridad a largo plazo son escasos.…”

Isoflavones derived from Glycine max (L.) Merr. in the treatment of vaginal atrophy: A new frontier

“…3 Despite the many safe and effective options for treating the changes caused by vulvovaginal atrophy (VVA), only a minority of women (about 25% in the Western world and probably much less in other areas) seek medical help. 4 One of the possible reasons for this behavior is the adverse publicity (not currently justified) disclosed in recent years for the use of hormone replacement therapy (HRT) in menopause.…”

“…3 Despite the many safe and effective options for treating the changes caused by vulvovaginal atrophy (VVA), only a minority of women (about 25% in the Western world and probably much less in other areas) seek medical help. 4 One of the possible reasons for this behavior is the adverse publicity (not currently justified) disclosed in recent years for the use of hormone replacement therapy (HRT) in menopause.It is worth mentioning that local treatment of VVA is not associated with the possible risks of systemic HRT. Among the reasons for not seeking treatment for VVA complaints are cultural ones and an understandable reluctance to discuss such issues, particularly with a male doctor.…”

Self-perception of sexual life and associated factors: a population study conducted in women aged 50 or more years

“…ET is also the best choice to treat severe symptoms of vulvar and vaginal atrophies (e.g. vaginal dryness, dyspareunia, and atrophic vaginitis) 5,6 . On the other hand, if left untreated, these symptoms may impair sexual function.…”