WISDOM survey: attitudes and behaviors of physicians toward vulvar and vaginal atrophy (VVA) treatment in women including those with breast cancer history

Kingsberg, Sheryl A.; Larkin, Lisa; Krychman, Michael; Parish, Sharon J.; Bernick, Brian; Mirkin, Sebastián

doi:10.1097/gme.0000000000001194

Cited by 36 publications

(20 citation statements)

References 48 publications

(56 reference statements)

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“…The median age at diagnosis is 62 years and most tumors are hormone-receptor positive. More than 60% of postmenopausal patients with breast cancer report symptoms of VVA, notably vaginal dryness and dyspareunia [72]. According to the consensus guidelines approved by NAMS and the International Society for the Study of Women’s Sexual Health, women with or at high risk for breast cancer should be offered non-hormonal therapies (e.g., moisturizers, lubricants, pelvic floor physical therapy, dilator therapy) as first-line treatments for symptom management.…”

Section: Available Treatmentsmentioning

confidence: 99%

“…In the WISDOM survey, the most common VVA treatment recommended by physicians was prescription therapy (alone or with other therapies), followed by OTC products alone, no treatment, behavioral/lifestyle management alone, and vaginal laser therapy alone [72]. Reasons given for these choices were efficacy, patient out-of-pocket cost, patient preference, and ease of use.…”

Section: Healthcare Provider Perspectivementioning

confidence: 99%

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Practical Treatment Considerations in the Management of Genitourinary Syndrome of Menopause

2019

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Genitourinary syndrome of menopause is a condition comprising the atrophic symptoms and signs women may experience in the vulvovaginal and bladder-urethral areas as a result of the loss of sex steroids that occurs with menopause. It is a progressive condition that does not resolve without treatment and can adversely affect a woman’s quality of life. For a variety of reasons, many symptomatic women do not seek treatment and, of those who do, many are unhappy with their options. Additionally, many healthcare providers do not actively screen their menopausal patients for the symptoms of genitourinary syndrome of menopause. In this review, we discuss the clinical presentation of genitourinary syndrome of menopause as well as the treatment guidelines recommended by the major societies engaged in women’s health. This is followed by a review of available treatment options that includes both hormonal and non-hormonal therapies. We discuss both the systemic and vaginal estrogen products that have been available for decades and remain important treatment options for patients; however, a major intent of the review is to provide information on the newer, non-estrogen pharmacologic treatment options, in particular oral ospemifene and vaginal prasterone. A discussion of adjunctive therapies such as moisturizers, lubricants, physical therapy/dilators, hyaluronic acid, and laser therapy is included. We also address some of the available data on both the patient and healthcare providers perspectives on treatment, including cost, and touch briefly on the topic of treating women with a history of, or at high risk for, breast cancer.

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Section: Available Treatmentsmentioning

confidence: 99%

Section: Healthcare Provider Perspectivementioning

confidence: 99%

Practical Treatment Considerations in the Management of Genitourinary Syndrome of Menopause

2019

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“…It is frequent to encounter a disconnection in education, communication, and information between HCPs and their menopausal patients (36). The WISDOM survey outlined that the comfort level of HCPs when prescribing VVA treatment is still suboptimal, in particular in case they are not gynecologists (37). Education of women, adequate training of HCPs and provision of communication tools in order to facilitate the “uncomfortable” dialogue are potential solutions to address the barriers currently impeding patient–clinician interactions around sexual health (38).…”

Section: Menopause and Urogenital Agingmentioning

confidence: 99%

Addressing Vulvovaginal Atrophy (VVA)/Genitourinary Syndrome of Menopause (GSM) for Healthy Aging in Women

et al. 2019

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Vaginal health is an essential component of active and healthy aging in women at midlife and beyond. As a consequence of hormonal deprivation and senescence, the anatomy and function of urogenital tissues are significantly affected and vulvovaginal atrophy (VVA) may occur. In a high proportion of postmenopausal women, progressive and chronic VVA symptoms have a strong impact on sexual function and quality of life. The new definition of genitourinary syndrome of menopause (GSM) comprises genital symptoms (dryness, burning, itching, irritation, bleeding), sexual symptoms (dyspareunia and other sexual dysfunctions) and urinary symptoms (dysuria, frequency, urgency, recurrent urinary infections). Many variables (age, sexual activity and partnership status) influence the clinical impact VVA/GSM symptoms and attitudes of elderly women to consult for receiving effective treatments. Psychosocial factors play a critical role in sexual functioning, but the integrity of the urogenital system is as well important affecting many domains of postmenopausal women's health, including sexual function. Several international surveys have extensively documented the need to improve VVA/GSM management because of the strong impact on women's daily life and on couple's intimacy. Health care providers (HCPs) need to be proactive in the early recognition of VVA/GSM in order to preserve urogenital and sexual longevity, by using hormonal and non-hormonal strategies. The clinical diagnosis is based on genital examination to identify objective signs and on the use of subjective scales to rate most bothersome symptoms (MBS), especially vaginal dryness. Recent studies point to the importance of addressing VVA/GSM as a potential early marker of poor general health in analogy with vasomotor symptoms. Therefore, a standard of VVA/GSM care in elderly women is desirable to enhance physical, emotional and mental well-being.

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“… 5 In women with significant VVA, including those with a history of hormone receptor-positive breast cancer, several medical societies support the use of vaginal estrogen therapy in consultation with an oncologist when symptomatic relief with non-hormonal products is insufficient. 10 Despite this guidance, physicians are generally not comfortable prescribing vaginal estrogen therapy to women with a history of breast cancer. 10 , 11 …”

Section: Introductionmentioning

confidence: 99%

“… 10 Despite this guidance, physicians are generally not comfortable prescribing vaginal estrogen therapy to women with a history of breast cancer. 10 , 11 …”

Section: Introductionmentioning

confidence: 99%

Experience with ospemifene in patients with vulvar and vaginal atrophy and a history of breast cancer: case studies

Lilue¹,

Palacios²,

Santofimia³

2020

DIC

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Women with breast cancer are at a higher risk of developing vulvar and vaginal atrophy (VVA), a major component of the genitourinary syndrome of menopause, due to the combined estrogen-depleting effects of chemotherapy, adjuvant hormone therapy, and menopause. Ospemifene is approved to treat VVA in postmenopausal women with a history of breast cancer after completion of all breast cancer (including adjuvant) treatments. This article examines the background characteristics and outcomes in two postmenopausal women with a history of breast cancer who were treated with ospemifene for VVA. In the first case, a 78-year-old postmenopausal woman developed VVA while on aromatase inhibitor therapy for breast cancer. In the second case, a 54-year-old woman developed VVA many years after completing breast cancer therapy but not long after menopause. Both women had meaningful symptomatic improvement within 3 months of starting ospemifene treatment. Further improvement allowed each woman to resume sexual relations which had been a concern at presentation. Mammography and breast ultrasound imaging indicated no changes in breast tissue during treatment. Ospemifene is a useful therapeutic option for postmenopausal women with VVA and a history of breast cancer.

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WISDOM survey: attitudes and behaviors of physicians toward vulvar and vaginal atrophy (VVA) treatment in women including those with breast cancer history

Cited by 36 publications

References 48 publications

Practical Treatment Considerations in the Management of Genitourinary Syndrome of Menopause

Practical Treatment Considerations in the Management of Genitourinary Syndrome of Menopause

Addressing Vulvovaginal Atrophy (VVA)/Genitourinary Syndrome of Menopause (GSM) for Healthy Aging in Women

Experience with ospemifene in patients with vulvar and vaginal atrophy and a history of breast cancer: case studies

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