Current challenges in the pharmacological management of genitourinary syndrome of menopause

Salvatore, Stefano; Benini, Vittoria; Ruffolo, Alessandro Ferdinando; Degliuomini, Rebecca; Redaelli, Anna; Casiraghi, Arianna; Candiani, Massimo

doi:10.1080/14656566.2022.2152326

Cited by 6 publications

(5 citation statements)

References 68 publications

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“…Several therapies are already available to treat VVA symptoms in menopausal women [ 26 , 27 ], including both systemic therapies such as ospemiphene [ 28 ], and local therapies such as vaginal estrogens and vaginal laser energies like the microablative fractional CO 2 laser or the erbium YAG laser [ 29 , 30 ], but none of these has been investigated in women affected by SSc. Further studies, however, are needed to evaluate the safety profile and the efficacy of these treatments on postmenopausal women affected by SSc complaining of VVA symptoms and sexual dysfunction.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Systemic Sclerosis on Sexual Health: An Italian Survey

Ruffolo,

Serati,

Casiraghi

et al. 2023

Healthcare

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Objective: To evaluate the impact of systemic sclerosis (SSc) on vulvovaginal atrophy (VVA) and sexual health in an Italian population. Methods: An Italian survey about the prevalence and severity of VVA (on a 0 to 10 scale) and sexual dysfunction (using the Female Sexual Function Index—FSFI) through an anonymous online questionnaire. We investigated couple relationships and intimacy with partners, the predisposition of patients to talk about their sexual problems, physicians’ receptivity, and treatment scenarios. Risk factors for VVA symptoms and sexual dysfunction were assessed. Results: A total of 107 women affected by SSc were enrolled. Of these, 83.2% of women (89/107) complained about VVA symptoms and 89.7% (among sexually active women; 87/97) about sexual dysfunction. Menopausal status did not affect VVA symptoms, while age was the only independent risk factor for sexual dysfunction. About 70% (74/107) of women reported a negative impact of disturbances on intimacy with their partner. A total of 63 women (58.9%) had never discussed their sexual problems and VVA condition with a physician. Lubricants were the only treatment prescribed, and 75% of women would welcome new therapies, even if experimental (62.9%). Conclusions: In women with SSc, VVA symptoms and sexual dysfunction are highly prevalent, independently from menopause. In more than half of the investigated women with SSc, we found reluctance to talk about their sexual problems, despite being symptomatic. This should encourage physicians to investigate vulvovaginal and sexual health. SSc patients would welcome the advent of new treatment possibilities for their VVA and sexual complaints.

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Section: Discussionmentioning

confidence: 99%

The Impact of Systemic Sclerosis on Sexual Health: An Italian Survey

Ruffolo,

Serati,

Casiraghi

et al. 2023

Healthcare

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“… 102 Also comparison of laser therapy with other hormonal treatments potentially safe in BCSs, such as vaginal prasterone 103 and oral ospemifene, 104 may expand the range of treatment options available in menopausal women 105 and in high-risk patients with GSM. 106 An aspect deserving further investigation is the possibility to combine laser therapy with other treatment strategies to maximize and/or maintain long-term positive effects. This approach could balance risks and benefits in BCSs, taking into account level of evidence and women’s preferences, as well as containing elevated costs for the healthcare system.…”

Section: Discussionmentioning

confidence: 99%

Genitourinary Syndrome of Menopause in Breast Cancer Survivors: Current Perspectives on the Role of Laser Therapy

Cucinella¹,

Tiranini²,

Cassani³

et al. 2023

IJWH

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Genitourinary syndrome of menopause (GSM) is a frequent consequence of iatrogenic menopause or anti-estrogenic adjuvant therapies in breast cancer survivors (BCSs). GSM may profoundly affect sexual health and quality of life, and a multidimensional unique model of care is needed to address the burden of this chronic heterogeneous condition. Severe symptoms may be insufficiently managed with non-hormonal traditional treatments, such as moisturizers and lubricants, recommended as the first-line approach by current guidelines, because concerns exist around the use of vaginal estrogens, particularly in women on aromatase inhibitors (AIs). Vaginal laser therapy has emerged as a promising alternative in women with GSM who are not suitable or do not respond to hormonal management, or are not willing to use pharmacological strategies. We aim to systematically review current evidence about vaginal laser efficacy and safety in BCSs and to highlight gaps in the literature. We analyzed results from 20 studies, including over 700 BCSs treated with either CO 2 or erbium laser, with quite heterogeneous primary outcomes and duration of follow up (4 weeks–24 months). Although evidence for laser efficacy in BCSs comes mostly from single-arm prospective studies, with only one randomized double-blind sham-controlled trial for CO 2 laser and one randomized comparative trial of erbium laser and hyaluronic acid, available data are reassuring in the short term and indicate effectiveness of both CO 2 and erbium lasers on the most common GSM symptoms. However, further studies are mandatory to establish long-term efficacy and safety in menopausal women, including BCSs.

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“…If, on the other hand, the disturbances refer only to the genital area, with vulvovaginal atrophy and consequent dyspareunia, preparations based on hyaluronic acid, estrogen, or androgens can be prescribed by the vaginal route, in the form of gels, creams, or ovules for topical application at the vaginal level. These are useful solutions for solving genitourinary problems [126,127]. Topical (topically applied) HRT does not resolve hot flushes, but it can act on vaginal dryness; these therapies usually consist of creams with estrogen in small quantities to be applied directly into the vagina [128,129].…”

Section: Managementmentioning

confidence: 99%

Treatments and Management of Menopausal Symptoms: Current Status and Future Challenges

Comparetto,

Borruto

2023

OBM Geriatr

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In the United States (US), menopause occurs at an average age of 52. Menopausal symptoms tend to be maximal during the few years before and the year after menopause (during perimenopause), except for symptomatic vulvovaginal atrophy, which may worsen over time. Up to 20% of bone density loss occurs during the first 5 years after menopause, followed by an age-related bone loss rate similar to that in men. Menopause should be considered confirmed if an age-appropriate woman who is not pregnant has not had a menstrual period for 12 months. Regarding treatment, for vaginal dryness or dyspareunia due to menopause, vaginal stimulation and vaginal lubricants and moisturizers are recommended, and if these are ineffective, low-dose vaginal estrogen, in the form of creams, tablets, suppositories, or rings should be considered; other options include oral ospemifene or intravaginal dehydroepiandrosterone (DEHA) suppositories. Before prescribing hormone replacement therapy (HRT) and periodically while therapy continues, women should be informed of risks (e.g., deep vein thrombosis [DVT], pulmonary embolism [PE], stroke, breast cancer, gallbladder disease, and urinary incontinence); potential harms are greatest for women who start HRT after 60 years of age or who are 10-20 years past menopause onset. If women choose HRT to relieve hot flushes, estrogen plus, a progestin or conjugated estrogen/bazedoxifene could be prescribed for women who still have the uterus. Treatment with HRT should be tailored to maximize benefits and minimize harms, and periodically benefits and harms should be reassessed; low-dose transdermal HRT may lead to a lower risk of DVT and stroke. Selective serotonin reuptakereuptake inhibitors (SSRIs), selective serotonin-nor-epinephrine reuptake inhibitors (SNRIs), and gabapentin could be considered as less effective alternatives to HRT for relieving hot flushes; paroxetine 7.5 milligrams (mg) is the only non-hormonal drug approved in the US for the relief of hot flushes. Effective non-drug options include cognitive behavioral therapy and hypnosis.

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Current challenges in the pharmacological management of genitourinary syndrome of menopause

Cited by 6 publications

References 68 publications

The Impact of Systemic Sclerosis on Sexual Health: An Italian Survey

The Impact of Systemic Sclerosis on Sexual Health: An Italian Survey

Genitourinary Syndrome of Menopause in Breast Cancer Survivors: Current Perspectives on the Role of Laser Therapy

Treatments and Management of Menopausal Symptoms: Current Status and Future Challenges

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