Treating dyspareunia caused by vaginal atrophy: a review of treatment options using vaginal estrogen therapy

Sa Kingsberg, S Kellogg, M Krychman, Sa Kingsberg, S Kellogg, M Krychman

Abstract

Vulvovaginal atrophy (VVA) and dryness are common symptoms of the decline in endogenous production of estrogen at menopause and often result in dyspareunia. Yet while 10% to 40% of women experience discomfort due to VVA, it is estimated that only 25% seek medical help. The main goals of treatment for vaginal atrophy are to improve symptoms and to restore vaginal and vulvar anatomic changes. Treatment choices for postmenopausal dyspareunia resulting from vulvovaginal atrophy will depend on the underlying etiology and might include individualized treatment. A number of forms of vaginal estrogen and manner of delivery are currently available to treat moderate to severe dyspareunia caused by VVA. They all have been shown to be effective and are often the preferred treatment due to the targeted efficacy for urogenital tissues while resulting in only minimal systemic absorption. Both healthcare professionals and patients often find it difficult to broach the subject of sexual problems associated with VVA. However, with minimal effort to initiate a conversation about these problems, healthcare providers can provide useful information to their postmenopausal patients in order to help them each choose the optimal treatment for their needs and symptoms.

Keywords: dyspareunia; postmenopausal vulvovaginal atrophy; vaginal estrogen therapy.

References

    1. The role of local vaginal estrogen for treatment of vaginal atrophy in postmenopausal women: 2007 position statement of The North American Menopause Society. Menopause. 2007;14(3):357–336.
    1. Kingsberg SA. Maintaining and evaluating quality of life after menopause. The Female Patient. 1996;(May Suppl)
    1. Utian WH, Janata JW, Kingsberg SA, Patrick LD. Determinants and Quantification of Quality of Life after Menopause: The Utian Menopause Quality of Life Score. In: Aso T, Yamahara T, Fujimoto S, editors. Menopause at the Millenium. Parthenon Publishing; New York: 2000. pp. 00–00.
    1. World Health Organization Education and treatment in human sexuality: the training of health professionals. Report of a WHO meeting; Q Corporation, 49 Sheridan Avenue, Albany, NY 12210. 2000.
    1. Nyirjesy P. Postmenopausal vaginitis. Curr Infect Dis Rep. 2007;9:480–484.
    1. Bachmann G, Eberg GA, Burd ID. Vulvovaginal complaints. In: Lobo RA, editor. Treatment of the Postmenopausal Woman: Basic and Clinical Aspects. Philadelphia PA: Lippincott Williams & Wilkins; 1999. pp. 195–201.
    1. Society of Obstetricians and Gynaecologists of Canada SOGC clinical practice guidelines. The detection and management of vaginal atrophy. Number 145, May 2004. Int J Gynaecol Obstet. 2005;88(2):222–228.
    1. Katz A. When sex hurts: menopause-related dyspareunia. Vaginal dryness and atrophy can be treated. Am J Nurs. 2007;107(7):34–6. 39.
    1. Freedman M. Vaginal pH, estrogen and genital atrophy. Menopause Management. 2008;17(4):9–13.
    1. Utian WH. Psychosocial and socioeconomic burden of vasomotor symptoms in menopause: a comprehensive review. Health Qual Life Outcomes. 2005;3:47.
    1. Levine KB, Williams RE, Hartmann KE. Vulvovaginal atrophy is strongly associated with female sexual dysfunction among sexually active postmenopausal women. Menopause. 2008;15(4 Pt 1):661–666.
    1. Kelley C. Estrogen and its effect on vaginal atrophy in post-menopausal women. Urol Nurs. 2007;27(1):40–45.
    1. Carcio H. Urogenital atrophy. A new approach to vaginitis diagnosis. Adv Nurse Pract. 2002;10(10):40–8. 51.
    1. Mehta A, Bachmann G. Vulvovaginal complaints. Clin Obstet Gynecol. 2008;51(3):549–555.
    1. Bachman GA, Nevadunsky NS. Diagnosis and treatment of atrophic vaginitis. Am Fam Physician. 2000;61(10):3090–3096.
    1. Suckling J, Lethaby A, Kennedy R. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev. 2003/2005;(4):CD001500.
    1. Woodcock J. Bridging what is known and what is not known: FDA perspective and response. 2002. US FDA CDER [serial online] . Accessed January 25, 2009.
    1. Grady D, Sawaya GF. Discontinuation of postmenopausal hormone therapy. Am J Med. 2005;118(suppl 12B):163–165.
    1. American College of Obstetricians and Gynecologists Task Force on Hormone Therapy Genitourinary tract changes. Obstet Gynecol. 2004;104(4 Suppl):56S–61S.
    1. Coulton CJ. Decision making in support: patient perceptions and preferences. J Clin Epidemiol. 1990;43(Suppl):51S–54S.
    1. Pace DT. Menopause: studying the research. Nurse Pract. 2006;31(8):17–23.
    1. Smith PE. Menopause assessment, treatment, and patient education. Nurse Pract. 2005;30(2):32–43.
    1. Theroux R, Taylor K. Women’s decision making about the use of hormonal and nonhormonal remedies for the menopausal transition. J Obstet Gynecol Neonatal Nurs. 2003;32(6):712–723.
    1. Aber CS, Arathuzik D, Righter AR. Women’s perceptions and concerns about menopause. Clin Excell Nurse Pract. 1998;2(4):232–238.
    1. Hutcherson HY, Kingsberg SA, Krychman ML, et al. A positive approach to female sexual health: A summary report. Female Patient. 2009;(Suppl April):1–6.
    1. Estrogen and estrogen with progestin therapies for postmenopausal women. US FDA CDER [serial online] 2008; Accessed January 25, 2009.
    1. Robb-Nicholson C. By the way, doctor. My doctor prescribed a low-dose vaginal estrogen cream, applied twice a week, for atrophic vaginitis. I’ve heard this dose is so low that it carries no health risk. Do you agree? Harv Womens Health Watch. 2007;15(3):7.
    1. Martin KA, Manson JE. Approach to the patient with menopausal symptoms. J Clin Endocrinol Metab. 2008;93(12):4567–4575.
    1. Bachman G, Bouchard C, Hoppe D, et al. Efficacy and safety of low-dose regimens of conjugated estrogens cream administered vaginally Menopause 2009; In Press.
    1. Weisberg E, Ayton R, Darling G, et al. Endometrial and vaginal effects of low-dose estradiol delivered by vaginal ring or vaginal tablet. Climacteric. 2005;8(1):83–92.
    1. Simon J, Nachtigall L, Gut R, Lang E, Archer DF, Utian W. Effective treatment of vaginal atrophy with an ultra-low-dose estradiol vaginal tablet. Obstet Gynecol. 2008;112(5):1053–1060.
    1. Basson R. Taking the sexual history, part 1: Eliciting the sexual concerns of your patient in primary care. Med Aspects Hum Sex. 2000;1(1):13–18.
    1. Plaut SM, Graziottin A, Heaton JPW. Health Press; 2004. FastFacts: Sexual Dysfunction.
    1. Kingsberg SA, Janata JW. Female sexual disorders: Assessment, diagnosis and treatment. Urol Clin N Am. 2007;34(4):497–506.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit