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Expert addresses therapeutic options for menopausal vulvovaginal atrophy
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The topic of therapeutic options for vulvovaginal atrophy at the pre-meeting symposium portion of the North American Menopause Society Annual Meeting was historically pertinent, according to Gloria A. Bachmann, MD, NCAS.
In JAMA in 1983, Bachmann and colleagues published research on vulvovaginal atrophy (VVA) and the influence of sexual activity and hormones. According to Bachmann, women who were sexually active appeared to have a better vaginal health index compared with women who were not sexually active.
“I’ve had a long-standing interest in this area, and I’m excited how we’re moving forward in this area of women’s health; looking at many types of options for women,” Bachmann, the interim chair in the department of obstetrics, gynecology and reproductive sciences at the Rutgers Robert Wood Johnson Medical School in New Brunswick, N.J., told Endocrine Today.
Clinical implications
Bachmann said endocrinologists should suggest any of the over-the-counter products currently available when presented with women who express distress due to VVA of any cause.
“The main message I would like to point out is that women along with their clinician should come up with what is best for them. Going through the pros and cons of each treatment option is a matter of trial and error sometimes for the patient,” Bachmann said, adding that it is not always about monotherapy.
“Many times, when we suggest therapy for VVA symptoms, the focus is on the sole use of local vaginal estrogen creams. However, some women may need a lubricant, too,” she said.
Ultimately, a multipronged approach may be necessary to give the patient the satisfaction she needs, Bachmann said.
Potential therapies
Patient preference is a large part of the patient-clinician decision process. According to Bachmann, nonhormonal therapies include:
- Household interventions: olive, almond, apricot oils or petroleum jelly;
- Plant or vitamin interventions: vitamin E capsules or suppositories, or black cohosh/wild yam suppositories;
- Regular sexual activity;
- Vaginal dilators;
- Pelvic floor physical activity; or
- Silicone-, water-, oil- and cream-based lubricants and moisturizers.
However, for women who do not experience satisfactory symptom relief from nonhormonal therapies, local vaginal estrogen products are potential options, Bachmann said.
Therefore, she listed the following hormonal therapies:
- Vaginal: 17 beta-estradiol, conjugated estrogens; 17 beta-estradiol, estradiol acetate rings; or estradiol hemihydrate tablets; or
- Systemic (should be used when there is another indication for their use, such as the treatment of vasomotor symptoms and VVA): 17 beta-estradiol, conjugated estrogens, synthetic conjugated estrogens, estropipate (formerly piperazine estrone sulfate).
Research is now examining new agents in the pipeline, including ospemifene for symptoms other than dyspareunia; the selective tissue estrogenic activity regulator bazedoxifene plus conjugated estrogens; intravaginal dehydroepiandrosterone; lower-dose estradiol cream; and an extended-release subtype-selective compound, according to Bachmann. – by Samantha Costa
For more information:
Bachmann G. Pre-Meeting Symposium: vulvovaginal health: let’s talk about it. Presented at: the North American Menopause Society 24th Annual Meeting; Oct. 9-12, 2013; Dallas.
Disclosure: Bachmann reports financial ties with Shionogi.