Diagnostics and management of vulvovaginal atrophy according to the international guidelines

Abstract

Vulvovaginal atrophy is one of the genitourinary symptoms caused by estrogen deficiency which leads to the development of immature vaginal epithelium, glycogen deficiency, reduction or even elimination of lactobacilli, and secondary genitourinary tract infection. Among the main symptoms were dryness, burning, itching, and dyspareunia. Diagnosis is typically based on the patient’s complaints, signs, and symptoms. Management of vulvovaginal atrophy includes various forms of topical estrogens and non-hormonal drugs. Low-dose vaginal estrogens can be used as monotherapy or as a supplement to hormone replacement therapy (HRT). In the case of monotherapy, there is no need to add progesterone for the endometrial protection. According to the recent studies, local vaginal estrogen therapy does not increase the risk of cancer, cardiovascular disease, and venous thromboembolism. On patients with hormonophobia, an alternative method of treatment is the use of vaginal lubricants and moisturizers or who have had cancers of various localization. For instance, usage of lactic acid vaginal gels in breast cancer survivors has improved vaginal dryness and dyspareunia as compared with the placebo. Yet, vaginal estrogen therapy has better clinical effects than non-hormonal drugs.