Knowledge of genito-urinary syndrome of menopause among Italian gynecologists: the DIADEM survey

Alvisi, Stefania; Baldassarre, Maurizio; Gava, Giulia; Mancini, Ilaria; Cagnacci, Angelo; Seracchioli, Renato; Meriggiola, Maria Cristina

doi:10.1016/j.maturitas.2020.09.011

Cited by 8 publications

(4 citation statements)

References 26 publications

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“…3 Despite its frequency and impact on the quality of life of postmenopausal women, GSM is still an underdiagnosed and undertreated condition, mainly due to the belief that GSM symptoms occur naturally due to aging and must be tolerated. 6 The first-line treatments for GSM include vaginal lubricants and moisturizers. Vaginal estrogen has been demonstrated to be effective in alleviating GSM.…”

Section: Introductionmentioning

confidence: 99%

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Physical energies for the management of genitourinary syndrome of menopause: An overview of a systematic review and network meta‐analysis

Sarmento,

de Araújo Santos Camargo,

de Freitas

et al. 2023

Intl J Gynecology & Obste

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BackgroundEnergy‐based devices (laser and radiofrequency) have been used to treat genitourinary syndrome of menopause (GSM).ObjectivesTo evaluate the efficacy and safety of physical energy use in managing GSM symptoms.Search StrategyFive databases were searched from inception to December 2022. Language restrictions were not imposed.Selection CriteriaWe included all Cochrane and non‐Cochrane systematic reviews with or without meta‐analyses that described postmenopausal women with symptoms of GSM treated with physical energy.Data Collection and AnalysisWe performed a network meta‐analysis using frequentist methods to calculate standardized mean differences (SMDs) and their corresponding 95% confidence intervals (CIs). Methodological and reporting quality were assessed using the Assessment of Multiple Systematic Reviews (AMSTAR 2).Main ResultsNine reviews were included in the overview, six of which were meta‐analyses. Four randomized controlled trials, representing 218 participants and nine different study arms, met the criteria for inclusion in our component network meta‐analysis. Confidence in review findings was low in six reviews and critically low in three. Our network meta‐analysis results showed that premarin (SMD 2.60, 95% CI 7.76–3.43), conjugated estrogens (SMD 2.13, 95% CI 1.34–2.91), carbon dioxide laser (SMD 1.71, 95% CI 1.10–2.31), promestriene (SMD 1.41, 95% CI 0.59–2.24), and vaginal lubricant (SMD 1.37, 95% CI 0.54–2.20) were more effective than sham for reducing sexual dysfunction, with a consequent increase in Female Sexual Function Index (FSFI). Two studies showed a high risk of bias, owing to a lack of blinding.ConclusionSeveral gaps in the use of physical energy for managing GSM still need to be addressed. The small number of blind clinical trials made the results fragile.

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Section: Introductionmentioning

confidence: 99%

“…Despite its frequency and impact on the quality of life of postmenopausal women, GSM is still an underdiagnosed and undertreated condition, mainly due to the belief that GSM symptoms occur naturally due to aging and must be tolerated 6 …”

Section: Introductionmentioning

confidence: 99%

Physical energies for the management of genitourinary syndrome of menopause: An overview of a systematic review and network meta‐analysis

Sarmento,

de Araújo Santos Camargo,

de Freitas

et al. 2023

Intl J Gynecology & Obste

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mentioning

confidence: 99%

“…V ulvovaginal atrophy (VVA) is a poorly recognized and undertreated chronic condition that occurs in approximately 50% of menopausal women, negatively affecting their personal lives and relationships. [1][2][3] The onset of this pathology is mainly associated with marked reduction in circulating estrogen levels, which leads to thinning of the vaginal epithelium, less vascularization, and less lubrication of the vagina. These modifications lead to symptoms such as vaginal dryness and superficial dyspareunia, which can be associated with itching, burning sensations, susceptibility to mechanical insults, leukorrhea, or atypical secretions.…”

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confidence: 99%

Effect of ospemifene on vaginal microbiome in postmenopausal women with vulvovaginal atrophy

et al. 2023

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Objectives: This study aimed (i) to compare the vaginal microbiome profiles of women suffering from vulvovaginal atrophy with that of healthy postmenopausal women and to (ii) assess the effect of ospemifene and systemic hormone treatment on the composition of the vaginal microbiome.Methods: Sixty-seven postmenopausal women attending the Gynecology Clinic of Azienda Ospedaliero-Universitaria of Bologna (Italy) were enrolled. Of them, 39 received a diagnosis of atrophy and 28 were considered healthy controls. In the group of atrophic women, 20 were prescribed ospemifene and 19 received hormone treatment. The vaginal health index was calculated, and a vaginal swab was collected for the assessment of vaginal maturation index and the analysis of vaginal microbiome through 16S rRNA gene sequencing. Clinical/microbiological analyses were repeated after 3 months of treatment.Results: The vaginal microbiome of atrophic women was characterized by a significant reduction of Lactobacillus (P = 0.002) and an increase of Streptococcus (P = 0.008) and Sneathia (P = 0.02). A positive correlation between vaginal health index/vaginal maturation index and Lactobacillus abundance was found (P = 0.002 and P = 0.035, respectively). Both therapeutic approaches effectively improved vaginal indices. Systemic hormone treatment induced changes in minority bacterial groups of the vaginal microbiome, whereas ospemifene was able to eliminate specific bacterial taxa, such as Staphylococcus (P = 0.04) and Clostridium (P = 0.01). Both treatments induced a trend in the increase of bifidobacteria.Conclusions: The vaginal microbiome of atrophic women differs significantly from that of healthy postmenopausal women. Ospemifene may lead to a condition of vaginal health, likely characterized by the reduction of "potentially harmful" bacteria.

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CO2-Laser therapy and Genitourinary Syndrome of Menopause: A Systematic Review and Meta-Analysis

Filippini

Porcari

Ruffolo

et al. 2022

The Journal of Sexual Medicine

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Background Genitourinary syndrome of menopause (GSM) is a widespread condition with a great impact on quality of life and self-image. Aim We aimed to systematically review the current literature on CO2-Laser therapy efficacy for the treatment of GSM. Methods MEDLINE and Embase databases were systematically queried in December 2020 Studies included women with a diagnosis of Vulvo-Vaginal Atrophy (VVA) or GSM without an history of gynaecological and/or breast cancer, pelvic organ prolapse staged higher than 2, pelvic radiotherapy or Sjogren’s Syndrome. The quality of the evidence was assessed with the Cochrane risk of bias tool. This study is registered on PROSPERO, number CRD42021238121. Outcomes Effects of CO2-Laser therapy on GSM symptoms assessed through subjective or objective efficacy measurement methods. Results A total of 803 articles were identified. Of these, 25 studies were included in this review for a total of 1,152 patients. All studies showed a significant reduction in VVA and/or GSM symptoms (dryness, dyspareunia, itching, burning, dysuria). The pooled mean differences for the symptoms were: dryness -5.15 (95% CI:-5.72,-4.58; P < .001; I2:62%; n = 296), dyspareunia -5.27 (95% CI:-5.93,-4.62; P < .001; I2:68%; n = 296), itching -2.75 (95% CI:-4.0,-1.51; P < .001; I2:93%; n = 281), burning -2.66 (95% CI:-3.75, -1.57; P < .001; I2:86%; n = 296) and dysuria -2.14 (95% CI:-3.41,-0.87; P < .001; I2:95%; n = 281). FSFI, WHIS and VMV scores also improved significantly. The pooled mean differences for these scores were: FSFI 10.8 (95% CI:8.41,13.37; P < .001; I2:84%; n = 273), WHIS 8.29 (95% CI:6.16,10.42; P < .001; I2:95%; n = 262) and VMV 30.4 (95% CI:22.38,38.55; P < .001; I2:24%; n = 68). CO2-Laser application showed a beneficial safety profile and no major adverse events were reported. Clinical Implications Vaginal laser treatment resulted in both a statistically and clinically significant improvement in GSM symptoms. FSFI improved significantly in all 8 included studies but it reached a clinically relevant level only in 2 of them. Strengths & Limitations The strength of the current meta-analysis is the comprehensive literature search. We reported data from a high number of patients (1,152) and high number of laser applications (more than 3,800). The main limitations are related to the high heterogeneity of the included studies investigating laser effects. Moreover, most of them are single center and nonrandomized studies. Conclusion The data suggest that CO2-Laser is a safe energy-based therapeutic option for the management of VVA and/or GSM symptoms in postmenopausal women; however, the quality of the body of evidence is “very low” or “low”.

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Knowledge of genito-urinary syndrome of menopause among Italian gynecologists: the DIADEM survey

Cited by 8 publications

References 26 publications

Physical energies for the management of genitourinary syndrome of menopause: An overview of a systematic review and network meta‐analysis

Physical energies for the management of genitourinary syndrome of menopause: An overview of a systematic review and network meta‐analysis

Effect of ospemifene on vaginal microbiome in postmenopausal women with vulvovaginal atrophy

CO2-Laser therapy and Genitourinary Syndrome of Menopause: A Systematic Review and Meta-Analysis

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