Prevalence and correlates of vaginal estrogenization in postmenopausal women in the United States

Lindau, Stacy Tessler; Dude, Annie; Gavrilova, Natalia S.; Hoffmann, Joscelyn N.; Schumm, L. Philip; McClintock, Martha K.

doi:10.1097/gme.0000000000000787

Cited by 19 publications

(20 citation statements)

References 43 publications

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“…As previously reported, participants who did not provide vaginal swab specimens were older, less likely to have graduated from high school, and less likely to report hormone therapy use or frequent sexual activity in the previous year. 18 Participants who did not provide specimens were also more likely to report lifetime sexual violence exposure, but there were no differences in past-year emotional abuse. Genitourinary symptom reporting was similar in both groups.…”

Section: Resultsmentioning

confidence: 93%

“…Genitourinary symptom reporting was similar in both groups. 18 The mean vaginal maturation value was 46.6 (SD .8) (Table 1); 43% had a maturation value less than 50, a commonly used threshold for distinguishing clinically significant vaginal atrophy.…”

Section: Resultsmentioning

confidence: 99%

“…Vaginal epithelial cytology samples from 1,028 (66%) participants were collected from vaginal self-swab specimens. Details about the collection protocol 17 and the evaluation of samples 18 have been described elsewhere, and the reliability of self-swab sampling has been previously validated. 19 Following standard protocols, samples were used to assess the proportion of parabasal, intermediate, or superficial vaginal epithelial cells.…”

Section: Methodsmentioning

confidence: 99%

“…Consistent with other observational and interventional studies of urogenital aging, 20–22 findings were then used to calculate the vaginal maturation value, a standardized tissue-based marker of vaginal atrophy. 18 A lower maturation value may signify genitourinary syndrome of menopause, a common chronic and progressive condition characterized by vulvovaginal, urinary, and/or sexual symptoms related to estrogen loss and vulvovaginal atrophy. 5…”

Section: Methodsmentioning

confidence: 99%

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Interpersonal trauma and aging-related genitourinary dysfunction in a national sample of older women

Gibson

Lisha

Walter

et al. 2019

American Journal of Obstetrics and Gynecology

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Background: Among reproductive-aged women, exposure to interpersonal trauma is associated with genitourinary symptoms. Little is known about the relationship between these exposures and the genitourinary health of older women, who tend to experience different and more prevalent genitourinary symptoms due to menopause and aging. Objectives: In this study, we examined relationships between common types of interpersonal trauma and aging-related genitourinary dysfunction among older women. Study Design: We analyzed data from the National Social Life, Health, and Aging Project, a national area probability sample of older community-dwelling adults born between 1920–1947. We used cross-sectional data from home-based study visits conducted in 2005–2006 to examine interpersonal violence exposures (any lifetime sexual assault, past-year emotional and physical abuse), and past-year genitourinary symptoms (urinary incontinence, other urinary problems, and vaginal pain/lubrication problems with sexual intercourse) among women participants. Multivariable logistic regression models were used to relate interpersonal violence and genitourinary symptoms, adjusting for age, race/ethnicity, body mass index, education, marital status, parity, hormone therapy, depressive and anxiety symptoms, and self-reported health. In exploratory models, we further adjusted for vaginal maturation, a tissue-specific marker of aging-related urogenital atrophy obtained from vaginal self-swabs. Results: In this national sample of 1,551 older women (mean age 69 ± 2 years), 9% reported sexual assault, 23% reported emotional abuse, and <1% reported physical abuse. Urinary incontinence and other urinary problems were reported by 42% and 17%, respectively, and 42% of sexually active women (n=527) reported vaginal symptoms with intercourse. In multivariable regression analyses adjusted for age, race/ethnicity, education, marital status, parity, hormone therapy, anxiety, depressive symptoms, and self-reported health, women with any lifetime history of sexual assault had 2.5 times the odds (95% CI 1.0–6.3) of vaginal symptoms, while women who reported past-year emotional abuse had higher odds of urinary incontinence (OR 1.7, 95% CI 1.2–2.4) and other urinary problems (OR 1.8, 95% CI 1.2–2.8). Among women who provided vaginal self-swabs (n=869), adjustment for vaginal maturation attenuated associations with other urinary problems (OR 1.6, 95% CI .9–2.6) and vaginal symptoms (OR 2.2, 95% CI 0.8–5.8). Conclusion: Sexual assault and emotional abuse may play a role in the development or experience of aging-related genitourinary dysfunction in older women. Clinicians caring for older women should recognize the prevalence and importance of traumatic exposures in health related to menopause and aging.

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Section: Resultsmentioning

confidence: 93%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Interpersonal trauma and aging-related genitourinary dysfunction in a national sample of older women

Gibson

Lisha

Walter

et al. 2019

American Journal of Obstetrics and Gynecology

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“…During postmenopause several problems exist, in early postmenopause vasomotor symptoms predominate and can continue for several years [ 1 ], afterwards other problems can appear such as cardiovascular risk increase [ 2 ] and greater risk of fracture due to osteoporosis [ 3 ]. Long-term oestrogen privation is associated with urinary incontinence [ 4 ] and vaginal atrophy [ 5 ]. It is known that the bladder and the inferior 2 thirds of the vagina are embryologically derived from the urogenital sinus [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Changes in microscopic analysis of the urinary sediment in postmenopausal women who receive vaginal conjugated oestrogens

Carranza-Lira

Cruz-Ramírez

Sulvaran-Victoria

2017

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IntroductionMicroscopic haematuria is common in adults and it has been reported in 13% of postmenopausal women.ObjectiveTo evaluate the changes in urinary sediment after the use of vaginal conjugated oestrogens.Material and methodsPostmenopausal women with vaginal dryness were studied. In all them a urinalysis was done, looking for density, pH, and the presence of leukocytes and erythrocytes. In order to be included in the study, all of the women had to have microscopic haematuria, considered as the presence of 3 or more erythrocytes in the urinary sediment. All received vaginally 1 g of conjugated equine oestrogens cream 3 times per week for one month, moment in which a new urinalysis was carried out and the same parameters were evaluated.ResultsTwenty-four women were studied. The median age was 62 years (40-83), and the time since menopause was 144 months (24-336). When comparing the values between baseline and end of treatment urinalyses, no significant differences in pH and urinary density were found. The number of leukocytes significantly decreased after treatment (3.0 [1-6] vs. 1.0 [1-6], p < 0.026), and the erythrocytes number decreased (4.5 [3-12] vs. 0.0 [0-2], p < 0.001).ConclusionIn postmenopausal women with microscopic haematuria and vaginal dryness, it is worth considering administration of local oestrogen for one month, and after repeat the urine exam, before deciding to begin the microscopic haematuria study protocol.

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Efficacy of Vaginal Estradiol or Vaginal Moisturizer vs Placebo for Treating Postmenopausal Vulvovaginal Symptoms

et al. 2018

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IMPORTANCE Nearly half of postmenopausal women report bothersome vulvovaginal symptoms, but few data support the efficacy of 2 commonly recommended treatments. OBJECTIVE To compare the efficacy of a low-dose vaginal estradiol tablet and a vaginal moisturizer, each vs placebo, for treatment of moderate-to-severe postmenopausal vulvovaginal symptoms. DESIGN, SETTING, AND PARTICIPANTS This 12-week multicenter randomized clinical trial enrolled postmenopausal women with moderate to severe symptoms of vulvovaginal itching, pain, dryness, irritation, or pain with penetration. INTERVENTIONS Vaginal 10-μg estradiol tablet (daily for 2 weeks, then twice weekly) plus placebo gel (3 times a week) (n = 102) vs placebo tablet plus vaginal moisturizer (n = 100) vs dual placebo (n = 100). MAIN OUTCOMES AND MEASURES The main outcome was decrease in severity (0-3) of most bothersome symptom (MBS) between enrollment and 12 weeks. Additional measures included a composite vaginal symptom score, Female Sexual Function Index (FSFI) score (2-36), modified Female Sexual Distress Score-Revised item 1, treatment satisfaction and meaningful benefit, Vaginal Maturation Index, and vaginal pH. RESULTS The 302 women had a mean (SD) age of 61 (4) years and were primarily white (267 [88%]), college educated (200 [66%]), and sexually active (245 [81%]). Most women (294 [97%]) provided data for the primary analysis. The most commonly reported MBS was pain with vaginal penetration (182 [60%]), followed by vulvovaginal dryness (63 [21%]). Mean baseline MBS severity was similar between treatment groups: estradiol, 2.4 (95% CI, 2.3 to 2.6); moisturizer, 2.5 (95% CI, 2.3 to 2.6); placebo, 2.5 (95% CI, 2.4 to 2.6). All treatment groups had similar mean reductions in MBS severity over 12 weeks: estradiol, −1.4 (95% CI, −1.6 to −1.2); moisturizer, −1.2 (95% CI, −1.4 to −1.0); and placebo, −1.3 (95% CI, −1.5 to −1.1). No significant differences were seen between estradiol (P = .25) or moisturizer (P = .31) compared with placebo. Mean total FSFI improvement was similar between estradiol (5.4; 95% CI, 4.0 to 6.9) and placebo (4.5; 95% CI, 2.8 to 6.1) (P = .64), and between moisturizer (3.1; 95% CI, 1.7 to 4.5) and placebo (P = .17). CONCLUSIONS AND RELEVANCE Our results suggest that neither prescribed vaginal estradiol tablet nor over-the-counter vaginal moisturizer provides additional benefit over placebo vaginal tablet and gel in reducing postmenopausal vulvovaginal symptoms. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02516202

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Prevalence and correlates of vaginal estrogenization in postmenopausal women in the United States

Cited by 19 publications

References 43 publications

Interpersonal trauma and aging-related genitourinary dysfunction in a national sample of older women

Interpersonal trauma and aging-related genitourinary dysfunction in a national sample of older women

Changes in microscopic analysis of the urinary sediment in postmenopausal women who receive vaginal conjugated oestrogens

Efficacy of Vaginal Estradiol or Vaginal Moisturizer vs Placebo for Treating Postmenopausal Vulvovaginal Symptoms

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