A Comparative Study of Safety and Efficacy of Continuous Low Dose Oestradiol Released From a Vaginal Ring Compared With Conjugated Equine Oestrogen Vaginal Cream in the Treatment of Postmenopausal Urogenital Atrophy

Ayton, R; Darling, G.; Murkies, Alice L.; Farrell, Elizabeth; Weisberg, Edith; Selinus, Ingemar; Fraser, Ian S.

doi:10.1097/00006254-199610000-00020

Cited by 7 publications

(14 citation statements)

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“…Step Four: First-Line Therapies for Women's Sexual Dysfunction During the fourth step, the healthcare provider works with the menopausal woman to consider using a drug or medical device to help manage her sexual complaint. First-line therapies include hormone therapy such as androgen therapy [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] and/or estrogen therapy (local and/or systemic) and/or progesterone therapy [60][61][62][63][64], dopamine agonists [65][66][67], phosphodiesterase type 5 inhibitors [68][69][70][71][72][73], topical vasodilators [74,75], and use of a vacuum clitoris therapy device [76][77][78].…”

Section: Figurementioning

confidence: 99%

“…In addition, there are a number of studies showing that hormone insufficiency states may also be caused by a number of clinical conditions and medications, including the use of estrogen therapy and, in particular, oral contraceptive therapy [5,[24][25][26]28,38]. It has been widely reported that local vaginal hormone therapy successfully improves vaginal lubrication, dryness, and dyspareunia [63,64]. There are also a number of studies that have shown alleviation of hormone deficiency-induced symptoms by systemic and/or localized sex steroid hormones with increased quality of life, sexual interest, arousal, and orgasmic function [60][61][62].…”

Section: Figurementioning

confidence: 99%

“…Based on blood test results, systemic androgen treatment may be achieved with bioidentical dehydroepiandrosterone (DHEA) alone [40,41,47,48,53] or systemic bioidentical testosterone alone [49,52,[55][56][57][58] or a combination of both. Based on the history and physical examination, local bioidentical estrogen treatment may be achieved with vestibular estradiol alone or intravaginal estradiol alone or a combination of both [60][61][62][63][64].…”

Section: Phasementioning

confidence: 99%

“…Daily application of a film of vestibular estrogen is recommended as well, because it promotes the health of the frenulum (the most sensitive part of the external genitalia), labia minora, urethral meatus, hymenal tissue, and vestibular glands. Intravaginal estradiol has also been proved safe, as there is no clinically relevant systemic absorption, and there is little risk of breast cancer, myocardial infarction, or stroke [60,61,63,64].…”

Section: Phasementioning

confidence: 99%

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Current Management Strategies of the Postmenopausal Patient with Sexual Health Problems

Goldstein¹

2007

The Journal of Sexual Medicine

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Introduction Sexual health concerns of menopausal women include decreases in sexual interest, arousal, lubrication, and orgasm, and increases in sexual pain, all of which may be associated with distress. Aim To review a step-care progression of sexual healthcare management: identification of the sexual health problem; education of the patient and the partner; modification of reversible causes; first-line therapies consisting of devices and medications; and second-line therapies with more invasive treatments including surgery. Methods The healthcare provider is presented with a clinical diagnosis and treatment paradigm that engages mind, body, and relationship issues proceeding step-wise in a rational and cost-effective fashion. Main Outcome Measure Literature review in women's sexual health. Results Women's health, including sexual health, is a fundamental human right. Supported by evidence-based data, a step-care approach to diagnosis and management of women with sexual health problems is advised. Multidisciplinary interventions should be considered as needed. Identification of sexual health concerns engages diagnostic components of psychologic consultation, history, physical examination, and laboratory testing as appropriate. Key to clinical assessment is the detailed sexual, medical, and psychosocial history. No agreement exists on necessary laboratory tests. Patient (and partner) education improves understanding of treatment options and expectations, and promotes a trusting patient–physician partnership. Modification of reversible causes includes sex therapy, lubricants, altering medications, modifying lifestyle and physical therapy for pelvic floor disorders. First-line therapies should be administered based upon diagnosis, needs, expectations, risks, benefits, and cost, and include medical devices and drugs such as hormones, vasoactive agents, dopamine agonists, topical steroids, anti-infectious agents, and analgesic agents. Second-line therapies, such as surgery, are initiated upon failure, insufficient response, or adverse side effects associated with one or more of the first-line therapies or patient preference. Conclusions For postmenopausal women with sexual dysfunction, a rational clinical management strategy begins with treatment options that are most reversible and least invasive and costly.

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Section: Figurementioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Section: Phasementioning

confidence: 99%

Section: Phasementioning

confidence: 99%

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Current Management Strategies of the Postmenopausal Patient with Sexual Health Problems

Goldstein¹

2007

The Journal of Sexual Medicine

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“…Low doses of systemic conjugated equine estrogen, with and without medroxyprogesterone acetate, reduced vaginal atrophy compared with placebo in several thousand healthy menopausal women [16]. A randomized clinical trial found that among postmenopausal women with vaginal atrophy, a continuous lowdose estradiol-releasing vaginal ring provided comparable relief and was more acceptable than conjugated equine estrogen vaginal cream [41]. Another comparative study of menopausal women found that local 25-hydroxy,17-b estradiol vaginal tablets and conjugated equine estrogen vaginal cream were equally efficacious in relieving vaginal atrophy, but the vaginal tablets produced less endometrial proliferation than the cream [42].…”

Section: Systemic Estrogen Therapy and Vaginal Atrophymentioning

confidence: 99%

Practical Aspects in the Management of Vaginal Atrophy and Sexual Dysfunction in Perimenopausal and Postmenopausal Women

Goldstein¹,

Alexander

2005

The Journal of Sexual Medicine

109

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Introduction The decline in circulating estrogen levels in peri- and postmenopause has a wide range of physiological effects, including atrophy of tissues in the urogenital tract. Vaginal atrophy is an important contributor to postmenopausal sexual dysfunction. Aim To provide a framework for clinical evaluation and clinical management of sexual dysfunction secondary to vaginal atrophy. Method Conduct a brief overview of literature on evaluation and treatment of vaginal atrophy, augmented with the authors’ clinical observations and experience. Results Estrogen decline disrupts many physiological responses characteristic of sexual arousal, including smooth muscle relaxation, vasocongestion, and vaginal lubrication; genital tissues depend on continued estrogen and androgen stimulation for normal function. An upward shift in vaginal pH as the result of vaginal atrophy alters the normal vaginal flora. Reduced lubrication capability and reduced tissue elasticity, in addition to shortening and narrowing of the vaginal vault, can lead to painful and/or unpleasant intercourse. At the same time, diminished sensory response may reduce orgasmic intensity. Other contributors to peri- and postmenopausal sexual dysfunction include reduced androgen levels, aging of multiple body systems, and side-effects of medications. Workup of sexual health problems starts by taking a comprehensive sexual, medical, and psychosocial history, followed by complete physical examination and laboratory evaluation. Clinical management includes measures to preserve and enhance overall health, adjustment of medication regimes to reduce or avoid side-effects, and topical or systemic hormone supplementation with estrogens and/or androgens. Conclusions No single therapeutic approach is appropriate for every woman with peri- or postmenopausal sexual dysfunction; instead, treatment should be based on a comprehensive evaluation and consideration of medical and psychosocial contributors to the individual's dysfunction. Further research is required to establish optimal regimens of hormonal and nonhormonal agents, including dosages/dosage forms and duration of treatment, for specific subtypes of sexual dysfunction.

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Chapitre 5 : Santé urogénitale

Author¹

2019

Journal of Obstetrics and Gynaecology Canada

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A Comparative Study of Safety and Efficacy of Continuous Low Dose Oestradiol Released From a Vaginal Ring Compared With Conjugated Equine Oestrogen Vaginal Cream in the Treatment of Postmenopausal Urogenital Atrophy

Cited by 7 publications

References 0 publications

Current Management Strategies of the Postmenopausal Patient with Sexual Health Problems

Current Management Strategies of the Postmenopausal Patient with Sexual Health Problems

Practical Aspects in the Management of Vaginal Atrophy and Sexual Dysfunction in Perimenopausal and Postmenopausal Women

Chapitre 5 : Santé urogénitale

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