open access

Vol 89, No 1 (2018)
Review paper
Published online: 2018-01-31
Get Citation

Post-menopausal vulvovaginal atrophy — an overview of the current treatment options

Jacek Krzysztof Szymański1, Bogumił Paweł Siekierski1, Anna Kajdy1, Grzegorz Jakiel2
DOI: 10.5603/GP.a2018.0008
·
Pubmed: 29411346
·
Ginekol Pol 2018;89(1):40-47.
Affiliations
  1. St Sophia Hospital in Warsaw, Żelazna 90 St., 01-004 Warsaw, Poland
  2. 1st Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland

open access

Vol 89, No 1 (2018)
REVIEW PAPERS Gynecology
Published online: 2018-01-31

Abstract

Sex hormone deficiency in post-menopausal women causes changes in the lower urinary tract. Vulvovaginal atrophy is a pathology resulting from those changes. VVA has a negative effect on the quality of life therefore prompting a search for new therapeutic options. The aim of this article is to summarize the current treatment modalities, both hormonal and non-hormonal for post-menopausal vaginal atrophy. Topical oestrogen therapy remains the “golden standard”. Alternatives, although promising, require well-designed control studies.

Abstract

Sex hormone deficiency in post-menopausal women causes changes in the lower urinary tract. Vulvovaginal atrophy is a pathology resulting from those changes. VVA has a negative effect on the quality of life therefore prompting a search for new therapeutic options. The aim of this article is to summarize the current treatment modalities, both hormonal and non-hormonal for post-menopausal vaginal atrophy. Topical oestrogen therapy remains the “golden standard”. Alternatives, although promising, require well-designed control studies.

Get Citation

Keywords

vulvovaginal atrophy, genitourinary syndrome of menopause, hormonal vaginal therapy, non-hormonal vaginal therapy, laser vaginal atrophy

About this article
Title

Post-menopausal vulvovaginal atrophy — an overview of the current treatment options

Journal

Ginekologia Polska

Issue

Vol 89, No 1 (2018)

Article type

Review paper

Pages

40-47

Published online

2018-01-31

DOI

10.5603/GP.a2018.0008

Pubmed

29411346

Bibliographic record

Ginekol Pol 2018;89(1):40-47.

Keywords

vulvovaginal atrophy
genitourinary syndrome of menopause
hormonal vaginal therapy
non-hormonal vaginal therapy
laser vaginal atrophy

Authors

Jacek Krzysztof Szymański
Bogumił Paweł Siekierski
Anna Kajdy
Grzegorz Jakiel

References (58)
  1. Abdi F, Darooneh T, Ghorbani M, et al. Transdermal hormone replacement therapy with nanostructured medicines. Ginekol Pol. 2017; 88(2): 103–108.
  2. Palacios S. Managing urogenital atrophy. Maturitas. 2009; 63(4): 315–318.
  3. Portman DJ, Gass MLS. Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society. J Sex Med. 2014; 11(12): 2865–2872.
  4. Farrell AE. Genitourinary syndrome of menopause. Aust Fam Physician. 2017; 46: 481.
  5. Gandhi J, Chen A, Dagur G, et al. Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management. Am J Obstet Gynecol. 2016; 215(6): 704–711.
  6. Palma F, Volpe A, Villa P, et al. Vaginal atrophy of women in postmenopause. Results from a multicentric observational study: The AGATA study. Maturitas. 2016; 83: 40–44.
  7. Kingsberg SA, Wysocki S, Magnus L, et al. Vulvar and vaginal atrophy in postmenopausal women: findings from the REVIVE (REal Women's VIews of Treatment Options for Menopausal Vaginal ChangEs) survey. J Sex Med. 2013; 10(7): 1790–1799.
  8. Simon JA, Nappi RE, Kingsberg SA, et al. Clarifying Vaginal Atrophy's Impact on Sex and Relationships (CLOSER) survey: emotional and physical impact of vaginal discomfort on North American postmenopausal women and their partners. Menopause. 2014; 21(2): 137–142.
  9. Thomas HM, Bryce CL, Ness RB, et al. Dyspareunia is associated with decreased frequency of intercourse in the menopausal transition. Menopause. 2011; 18(2): 152–157.
  10. Ambler DR, Bieber EJ, Diamond MP. Sexual function in elderly women: a review of current literature. Rev Obstet Gynecol. 2012; 5(1): 16–27.
  11. Brodowska A, Laszczynska M, Starczewski A, et al. The localization of estrogen receptor alpha and its function in ovaries of postmenopausal women. Folia Histochem Cytobiol. 2007; 45: 325.
  12. Taylor AH, Al-Azzawi F. Immunolocalisation of oestrogen receptor beta in human tissues. J Mol Endocrinol. 2000; 24(1): 145–155.
  13. Chen GD, Oliver RH, Leung BS, et al. Estrogen receptor alpha and beta expression in the vaginal walls and uterosacral ligaments of premenopausal and postmenopausal women. Fertil Steril. 1999; 71(6): 1099–1102.
  14. Gebhart JB, Rickard DJ, Barrett TJ, et al. Expression of estrogen receptor isoforms alpha and beta messenger RNA in vaginal tissue of premenopausal and postmenopausal women. Am J Obstet Gynecol. 2001; 185(6): 1325–30; discussion 1330.
  15. Fagan DH, Yee D. Crosstalk between IGF1R and estrogen receptor signaling in breast cancer. J Mammary Gland Biol Neoplasia. 2008; 13(4): 423–429.
  16. Fagan DH, Uselman RR, Sachdev D, et al. Acquired resistance to tamoxifen is associated with loss of the type I insulin-like growth factor receptor: implications for breast cancer treatment. Cancer Res. 2012; 72(13): 3372–3380.
  17. Fan P, Wang J, Santen RJ, et al. Long-term treatment with tamoxifen facilitates translocation of estrogen receptor alpha out of the nucleus and enhances its interaction with EGFR in MCF-7 breast cancer cells. Cancer Res. 2007; 67(3): 1352–1360.
  18. Fan P, Maximov PY, Curpan RF, et al. The molecular, cellular and clinical consequences of targeting the estrogen receptor following estrogen deprivation therapy. Mol Cell Endocrinol. 2015; 418 Pt 3: 245–263.
  19. Shou J, Massarweh S, Osborne CK, et al. Mechanisms of tamoxifen resistance: increased estrogen receptor-HER2/neu cross-talk in ER/HER2-positive breast cancer. J Natl Cancer Inst. 2004; 96(12): 926–935.
  20. Sawczuk B, Gołębiewska M, Mazurek A, et al. Immunohistochemical evaluation of oestrogen receptors α and β in epithelium of the vaginal mucous membrane in women after oestrogen therapy. Prz Menopauzalny. 2017; 16(1): 12–18.
  21. Gaspar A, Brandi H, Gomez V, et al. Efficacy of Erbium:YAG laser treatment compared to topical estriol treatment for symptoms of genitourinary syndrome of menopause. Lasers Surg Med. 2017; 49(2): 160–168.
  22. Montoya TI, Maldonado PA, Acevedo JF, et al. Effect of vaginal or systemic estrogen on dynamics of collagen assembly in the rat vaginal wall. Biol Reprod. 2015; 92(2): 43.
  23. Pinkerton JV, et al. Sánchez Agirre F, Blake J The 2017 hormone therapy position statement of The North American Society. Menopause. 2017; 24: 278.
  24. Bachmann GA, Nevadunsky NS, et al. Diagnosis and treatment of atrophic vaginitis. Am Fam Physician 2000, 61, 3090 Botsis D, Kassanos D, Antoniou G, Transvaginal sonography in postmenopausal women treated with low – dose estrogens locally administered. Maturitas. 1996; 23: 4.
  25. Sousa MS, Peate M, Jarvis S, et al. A clinical guide to the management of genitourinary symptoms in breast cancer survivors on endocrine therapy. Ther Adv Med Oncol. 2017; 9(4): 269–285.
  26. Kokot-Kierepa M, Bartuzi A, Kulik-Rechberger B, et al. Lokalna terapia estrogenowa – implikacje kliniczne- 2012 update. Ginekol Pol. 2012; 83: 772.
  27. Santen RJ. Vaginal administration of estradiol: effects of dose, preparation and timing on plasma estradiol levels. Climacteric. 2015; 18(2): 121–134.
  28. Lethaby A, Ayeleke RO, Roberts H. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev. 2016(8): CD001500.
  29. Origoni M, Cimmino C, Carminati G, et al. Postmenopausal vulvovaginal atrophy (VVA) is positively improved by topical hyaluronic acid application. A prospective, observational study. Eur Rev Med Pharmacol Sci. 2016; 20(20): 4190–4195.
  30. Bachmann G. Urogenital ageing: an old problem newly recognized. Maturitas. 1995; 22 Suppl: S1–S5.
  31. Jokar A, Davari T, Asadi N, et al. Comparison of the Hyaluronic Acid Vaginal Cream and Conjugated Estrogen Used in Treatment of Vaginal Atrophy of Menopause Women: A Randomized Controlled Clinical Trial. Int J Community Based Nurs Midwifery. 2016; 4(1): 69–78.
  32. Le Donne M, Caruso C, Mancuso A, et al. The effect of vaginally administered genistein in comparison with hyaluronic acid on atrophic epithelium in postmenopause. Arch Gynecol Obstet. 2011; 283(6): 1319–1323.
  33. Tersigni C, Di Simone N, Tempestilli E, et al. Non-hormonal treatment of vulvo-vaginal atrophy-related symptoms in post-menopausal women. J Obstet Gynaecol. 2015; 35(8): 835–838.
  34. Sturdee DW, Panay N. Recommendations for the management of postmenopausal vaginal atrophy. Climacteric. 2010; 13(6): 509–522.
  35. van der Laak JA, de Bie LMT, de Leeuw H, et al. The effect of Replens on vaginal cytology in the treatment of postmenopausal atrophy: cytomorphology versus computerised cytometry. J Clin Pathol. 2002; 55(6): 446–451.
  36. Portman D, Palacios S, Nappi RE, et al. Ospemifene, a non-oestrogen selective oestrogen receptor modulator for the treatment of vaginal dryness associated with postmenopausal vulvar and vaginal atrophy: a randomised, placebo-controlled, phase III trial. Maturitas. 2014; 78(2): 91–98.
  37. Constantine G, Graham S, Portman DJ, et al. Female sexual function improved with ospemifene in postmenopausal women with vulvar and vaginal atrophy: results of a randomized, placebo-controlled trial. Climacteric. 2015; 18(2): 226–232.
  38. Bachmann GA, Komi JO. Ospemifene Study Group. Ospemifene effectively treats vulvovaginal atrophy in postmenopausal women: results from a pivotal phase 3 study. Menopause. 2010; 17(3): 480–486.
  39. Simon J, Lin V, Radovich C, et al. One-year long-term safety extension study of ospemifene for the treatment of vulvar and vaginal atrophy in postmenopausal women with a uterus. Menopause: The Journal of The North American Menopause Society. 2012: 1.
  40. Simon J, Portman D, Mabey RG, et al. Ospemifene Study Group. Long-term safety of ospemifene (52-week extension) in the treatment of vulvar and vaginal atrophy in hysterectomized postmenopausal women. Maturitas. 2014; 77(3): 274–281.
  41. Portman D, Bachmann G, Simon J. Ospemifene, a novel selective estrogen receptor modulator for treating dyspareunia associated with postmenopausal vulvar and vaginal atrophy. Menopause. 2013; 20(6): 623–630.
  42. Alvisi S, Baldassarre M, Martelli V, et al. Effects of ospemifene on vaginal epithelium of post-menopausal women. Gynecological Endocrinology. 2017; 33(12): 946–950.
  43. Shin JJ, Kim SKi, Lee JR, et al. Ospemifene: A Novel Option for the Treatment of Vulvovaginal Atrophy. J Menopausal Med. 2017; 23(2): 79–84.
  44. European Medicines Agency Summary of opinion Senshio (ospemifene) http://www ema europa eu/docs/en_GB/document_library/Summary_of_opinion_-_Initial_authorisation/human/002780/WC500177633 pdf (access: 2017.12.11).
  45. Karwowski W, Lekesiz K, Koc-Żórawska E, et al. Effects of 17β-estradioland raloxifene on endothelial OPG and RANKL secretion. Ginekol Pol. 2017; 88(4): 167–173.
  46. Xu Y, Ma Xp, An Jn, et al. Short-time QiBaoMeiRan Formula Treatment Exerts Estrogenic Activities without Side Effects on Reproductive Tissues in Immature Mice. Sci Rep. 2015; 5: 17436.
  47. Masui F, Matsuda M, Mori T. Involvement of keratinocyte growth factor (KGF)-KGF receptor signaling in developmental estrogenization syndrome of mouse vagina. Cell Tissue Res. 2004; 318(3): 591–598.
  48. Hom YK, Young P, Thomson AA, et al. Keratinocyte growth factor injected into female mouse neonates stimulates uterine and vaginal epithelial growth. Endocrinology. 1998; 139(9): 3772–3779.
  49. Ceccarelli S, D'Amici S, Vescarelli E, et al. Topical KGF treatment as a therapeutic strategy for vaginal atrophy in a model of ovariectomized mice. J Cell Mol Med. 2014; 18(9): 1895–1907.
  50. Karcher C, Sadick N. Vaginal rejuvenation using energy-based devices. Int J Womens Dermatol. 2016; 2(3): 85–88.
  51. Vicariotto F, DE Seta F, Faoro V, et al. Dynamic quadripolar radiofrequency treatment of vaginal laxity/menopausal vulvo-vaginal atrophy: 12-month efficacy and safety. Minerva Ginecol. 2017; 69(4): 342–349.
  52. Gambacciani M, Levancini M, Cervigni M. Vaginal erbium laser: the second-generation thermotherapy for the genitourinary syndrome of menopause. Climacteric. 2015; 18(5): 757–763.
  53. Gambacciani M, Torelli MG, Martella L, et al. Rationale and design for the Vaginal Erbium Laser Academy Study (VELAS): an international multicenter observational study on genitourinary syndrome of menopause and stress urinary incontinence. Climacteric. 2015; 18 Suppl 1: 43–48.
  54. Pitsouni E, Grigoriadis T, Tsiveleka A, et al. Microablative fractional CO 2 -laser therapy and the genitourinary syndrome of menopause: An observational study. Maturitas. 2016; 94: 131–136.
  55. Siliquini GP, Tuninetti V, Bounous VE, et al. Fractional CO2 laser therapy: a new challenge for vulvovaginal atrophy in postmenopausal women. Climacteric. 2017; 20(4): 379–384.
  56. Behnia-Willison F, Sarraf S, Miller J, et al. Safety and long-term efficacy of fractional CO2 laser treatment in women suffering from genitourinary syndrome of menopause. Eur J Obstet Gynecol Reprod Biol. 2017; 213: 39–44.
  57. Zerbinati N, Serati M, Origoni M, et al. Microscopic and ultrastructural modifications of postmenopausal atrophic vaginal mucosa after fractional carbon dioxide laser treatment. Lasers Med Sci. 2015; 30(1): 429–436.
  58. Pitsouni E, Grigoriadis T, Falagas ME, et al. Laser therapy for the genitourinary syndrome of menopause. A systematic review and meta-analysis. Maturitas. 2017; 103: 78–88.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk
tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl