Systemic and local effects of vaginal dehydroepiandrosterone (DHEA): NCCTG N10C1 (Alliance)

Barton, Debra L.; Shuster, Lynne T.; Dockter, Travis; Atherton, Philip J.; Thielen, Jacqueline M.; Birrell, Stephen N.; Sood, Richa; Griffin, Patricia; Terstriep, Shelby A.; Mattar, Bassam; Lafky, Jacqueline M.; Loprinzi, Charles L.

doi:10.1007/s00520-017-3960-9

Cited by 55 publications

(59 citation statements)

References 33 publications

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“…No elevations in serum estradiol levels were seen in women on AIs. 44 In contrast, other studies (not performed in cancer survivors) indicated that there was no significant change in serum steroid levels, including estradiol, estrone, DHEA, and testosterone. 45 DHEA 6.5 mg (0.5%) use for up to 52 weeks in 422 women was associated with endometrial atrophy or inactive endometrium on endometrial biopsy samples.…”

Section: Vaginal Estrogensmentioning

confidence: 90%

Management of genitourinary syndrome of menopause in female cancer patients: a focus on vaginal hormonal therapy

Crean-Tate

Faubion

Pederson

et al. 2020

American Journal of Obstetrics and Gynecology

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Section: Vaginal Estrogensmentioning

confidence: 90%

Management of genitourinary syndrome of menopause in female cancer patients: a focus on vaginal hormonal therapy

Crean-Tate

Faubion

Pederson

et al. 2020

American Journal of Obstetrics and Gynecology

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“…25 Peripheral blood analysis (N 5 345) showed that circulating dehydroepiandrosterone-sulfate and testosterone levels were significantly increased in patients receiving vaginal DHEA in a dose-dependent manner compared with moisturizer. 44 Estradiol was significantly increased in those receiving 6.5 mg/d DHEA, but not in those receiving 3.25 mg/d DHEA or AI therapy. Mean estradiol concentration remained less than 5 pg/mL in both DHEA arms.…”

Section: Vaginal Estrogen Testosterone and Dhea Therapymentioning

confidence: 86%

“…24 Vaginal dehydroepiandrosterone (DHEA), also known as prasterone, has been studied as a treatment of GSM. Barton et al 25,44 conducted a phase III randomized clinical trial that evaluated two doses (3.25 and 6.5 mg/d) of vaginal DHEA gel compared with plain moisturizer for the improvement of vaginal symptoms (dryness or dyspareunia) in postmenopausal women (N 5 464) with a history of breast (97%) or gynecologic cancer who could be receiving endocrine therapy (56%). All arms reported an improvement in symptoms using the Female Sexual Function Index.…”

Section: Vaginal Estrogen Testosterone and Dhea Therapymentioning

confidence: 99%

“…Mean estradiol concentration remained less than 5 pg/mL in both DHEA arms. 44 Vaginal DHEA (prasterone Intrarosa, [AMAG Pharmaceuticals, Waltham, MA] 6.5 mg/d) is currently FDA-approved for treatment of GSM. Although this study shows that vaginal DHEA causes an increase in hormone concentrations, levels remain in the lowest half or quartile of the postmenopausal range.…”

Section: Vaginal Estrogen Testosterone and Dhea Therapymentioning

confidence: 99%

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Managing Genitourinary Syndrome of Menopause in Breast Cancer Survivors Receiving Endocrine Therapy

Sussman

Kruse

Thacker

et al. 2019

JOP

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Patients with breast cancer receiving antiestrogen therapy, specifically aromatase inhibitors, often suffer from vaginal dryness, itching, irritation, dyspareunia, and dysuria, collectively known as genitourinary syndrome of menopause (GSM). GSM can decrease quality of life and is undertreated by oncologists because of fear of cancer recurrence, specifically when considering treatment with vaginal estrogen therapy because of unknown levels of systemic absorption of estradiol. In this article, we review the available literature for treatment of GSM in patients with breast cancer and survivors, including nonhormonal, vaginal hormonal, and systemic hormonal therapy options. First-line treatment includes nonhormonal therapy with vaginal moisturizers, lubricants, and gels. Although initial studies showed significant improvement in symptoms, the US Food and Drug Administration recently issued a warning against CO2 laser therapy for treatment of GSM until additional studies are conducted. In severe or refractory GSM, after discussing risks and benefits of vaginal hormonal therapy, the low-dose 10-μg estradiol-releasing intravaginal tablet or lower-dose 4 μg estrogen vaginal insert and intravaginal dehydroepiandrosterone (prasterone) are options for treatment, because studies show minimal elevation in serum estradiol levels and significant improvement in symptoms. The decision to offer vaginal estrogen therapy must be individualized and made jointly with the patient and her oncologist.

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“…Unlike Vasomotor symptoms GSM /VVA does not resolve spontaneously; rather there is a progressive and cumulative negative effect over the time [15]. Long-term therapy may be necessary to maintain urogenital health [16].…”

Section: Anatomical Changes Responsible For the Symptomsmentioning

confidence: 99%

Genito Urinary Syndrome of Menopause (GSM) or Vulvo-vaginal Atrophy (VVA) an Unspoken Sorrow

Nasreen¹,

Shahreen²,

Huq³

et al. 2019

AJIM

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GSM includes wide spectrum of vulvovaginal Symptoms and urinary troubles replacing the term vulvovaginal atrophy (VVA). It is a silent epidemic condition affecting 50-60% postmenopausal women. Estrogen withdrawal causes thinning, narrowing, tissue loss & reduced blood supply in vulvo-vaginal area, which results GSM. GSM causes burning in vagina, dyspareunia, urinary urgency, repeated UTI. Dyspareunia affects all the domain of sexual function and deteriorates the quality of life. Irony is, women are oblivious to share and doctors are reluctant to discuss. So women keep continue suffering without knowing the restorative treatment. Repercussion of GSM/VVA intensifies the sorrows, distress and sufferings. It has profound effect on relationship and psychology and quality of life of women. Good history taking and clinical examination do diagnosis. Investigations are done to exclude other causes. Treatment is challenging. Maintenance of optimum body weight, exercise, regular coitus, quitting smoking & excessive alcohol intake are the key factors. Vaginal moisturizers are recommended as 1st line therapy for mild to moderate VVA or women who can't take estrogen. Ideal moisturizers should have similarity with vaginal secretion of osmolality, pH and composition. Meta analysis shows local estrogen therapy is effective. It restores vaginal pH and maturation index. Systemic absorption is minimal so progesterone needs not to be added. Testosterone improves dyspareunia, sexual desire, lubrication and satisfaction. DHEA (Prasterone) penetrates vaginal wall better. It increases elasticity and vascularity of vagina. RCTs have not shown benefits of it's systemic therapy. But local daily administration of DHEA reduces dyspareunia and GSM so improves the quality of life. Ospemifene is well tolerated. It's agonist effect on vaginal mucosa and antagonist effect on endometrium and breast, makes it promising. Lasofoxifene, third generation SERM, is also very effective but it needs FDA approval. Laser is widely being used and very effective. It is simple, faster, painless procedure. It activates dominant fibroblasts, proteoglycans, hyaluronic acid, thereby improves GSM & sexuality. Black cohosh, Botox, G-shot, probiotics, gabapentin are not yet evidence based. Still there is significant unmet need for medical treatment. Women reports GSM but that is only tip of iceberg. Good communication and optimum treatment only can break the sorrows GSM/VVA.

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Systemic and local effects of vaginal dehydroepiandrosterone (DHEA): NCCTG N10C1 (Alliance)

Cited by 55 publications

References 33 publications

Management of genitourinary syndrome of menopause in female cancer patients: a focus on vaginal hormonal therapy

Management of genitourinary syndrome of menopause in female cancer patients: a focus on vaginal hormonal therapy

Managing Genitourinary Syndrome of Menopause in Breast Cancer Survivors Receiving Endocrine Therapy

Genito Urinary Syndrome of Menopause (GSM) or Vulvo-vaginal Atrophy (VVA) an Unspoken Sorrow

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