Update on management of genitourinary syndrome of menopause: A practical guide

Palacios, Santiago; Castelo-Branco, Camil; Currie, Heather; Mijatovic, Velja; Nappi, Rossella E.; Simon, James A.; Rees, Margaret

doi:10.1016/j.maturitas.2015.07.020

Cited by 122 publications

(71 citation statements)

References 55 publications

(59 reference statements)

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“…For local estrogen therapy, there are no clinical trial safety data extending beyond 12 months, but no time limits for duration of therapy have been established. Since symptoms commonly return when treatment is discontinued, treatment should not be time-limited [15,18]. Appropriate monitoring should be considered.…”

Section: Resultsmentioning

confidence: 99%

“…The same paper states that with appropriate clinical surveillance, vaginal estrogens or ospemifene can be continued as long as bothersome symptoms are present (Level C). In their very recent update on VVA management, Palacios et al state that in general it is probably prudent to review women’s needs annually to assess efficacy and acceptability of therapy, while updating on any new advice, information, or treatment options [18]. …”

Section: Resultsmentioning

confidence: 99%

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Diagnosis and management of symptoms associated with vulvovaginal atrophy: expert opinion on behalf of the Italian VVA study group

Nappi

Biglia

Cagnacci

et al. 2016

Gynecological Endocrinology

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Vulvovaginal atrophy (VVA) is a chronic disorder that commonly occurs in postmenopausal women, whose symptoms are recognized among the most frequent and bothersome symptoms associated with menopause. The principal therapeutic goal in managing VVA is to relieve symptoms as well as to restore the vaginal environment to a healthy state. However, despite its high prevalence and negative impact on quality of life, VVA is underreported by women, underrecognized by gynecologists, and therefore, undertreated. In the light of the new development of treatment options for VVA, we here provide an updated expert opinion on the management of VVA. In particular, we strongly recommend that HCPs proactively start an open discussion with their postmenopausal patients about urogenital symptoms. Treatment should be started as early as the first symptoms of VVA occur and should be maintained over time, due to the chronicity of the conditions. Many treatment options are now available and therapy should be individualized, taking the woman’s preference in consideration.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Diagnosis and management of symptoms associated with vulvovaginal atrophy: expert opinion on behalf of the Italian VVA study group

Nappi

Biglia

Cagnacci

et al. 2016

Gynecological Endocrinology

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“…La THS local y sistémica se han mostrados como las más efectivas para casos moderados y severos, y además, también disponemos de los tratamientos no hormonales vaginales (hidratantes y lubricantes) (42). Nuevos y emergentes tratamientos como el Ospemifeno (Selective Estrogen Re-ceptor Modulator-SERM) (93-99), los derivados de la Testosterona, una combinación de E y Bazedoxifeno (Tissue Selective Estrogen Complex-TSEC) (100-104), y el láser vaginal, han demostrado beneficios en el tratamiento de los síntomas del SGM (7,13,14,17,38,103,104).…”

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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“…It is a clear example of the beneficial role hormone therapy can play in reversing FSDs. Local estrogen therapy is a first-line and well-established strategy to relieve VVA/GSM symptoms, whereas ospemifene oral tablets (Osphena/Senshio, Shionogi & Co, Ltd., London, UK), an estrogen selective receptor modulator, and dehydroepiandrosterone (DHEA) vaginal inserts (Intrarosa, Endoceutics, Inc., MSH, Québec Canada), a prohormone with both estrogenic and androgenic activity, were approved only recently for the treatment of dyspareunia and other symptoms associated with VVA/GSM [5]. These drugs effectively ameliorate sexual function in postmenopausal women, when treating sexual pain associated with VVA/GSM.…”

Section: Introductionmentioning

confidence: 99%

“…Their positive effect against placebo is evident during the first three months of treatment, and it is supported by a significant improvement in objective parameters, such as vaginal pH and maturation index. Safety data are currently available for the first year of therapy [5][6][7]. Differently from VVA/GSM, in which signs associated with symptoms are visible and can be monitored through a gynecological examination, the assessment and manage- ment of hypoactive desire disorder (HSDD) require screener questions and/or inquiring about a history of modifiable biopsychosocial factors influencing sexual health [8].…”

Section: Introductionmentioning

confidence: 99%

What are the challenges in prescribing pharmacotherapy for female sexual dysfunctions?

Nappi

Gardella

2019

Expert Opinion on Pharmacotherapy

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Update on management of genitourinary syndrome of menopause: A practical guide

Cited by 122 publications

References 55 publications

Diagnosis and management of symptoms associated with vulvovaginal atrophy: expert opinion on behalf of the Italian VVA study group

Diagnosis and management of symptoms associated with vulvovaginal atrophy: expert opinion on behalf of the Italian VVA study group

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

What are the challenges in prescribing pharmacotherapy for female sexual dysfunctions?

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