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2013: A year of name changes and nonhormonal treatments for women’s endocrine health
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Looking back on 2013, the clinicians who participated in The North American Menopause Society annual meeting will recall a year of change regarding nomenclature and new therapies for women’s endocrine-based reproductive health.
Vulvovaginal atrophy terminology
On the heels of renaming polycystic ovary syndrome, the International Society for the Study of Women’s Sexual Health and The North American Menopause Society (NAMS) partnered last spring and summer to explore the appropriateness of the terminology being used for vulvovaginal atrophy. We conducted a 2-day workshop including small group discussions to determine whether the terminology should be changed and, if so, how it could be improved. Several limitations were identified: 1) the term “vulvovaginal atrophy” does not identify the indication for treatment, which is the presence of symptoms; 2) the word “atrophy” is not well received by women; and 3) the term does not include the lower urinary tract, which can also be involved in symptoms.
Margery L.S. Gass
At the conclusion of the workshop, there was agreement that we wanted the term to identify the problem (that women were having symptoms), locate where the problem occurs anatomically (genitourinary) and relate it to the instigating time of life (menopause). Of all the terms that could be used to refer to symptoms, it was thought that “syndrome” was the most neutral. The result was “genitourinary syndrome of menopause” (GSM).
We selected “genitourinary” (as opposed to “urogenital”) because most of the symptoms reside within the genitals and not the urinary tract. In addition, we did not want to call it a deficiency state or disease. We wanted a term that was more neutral, so we chose “syndrome.” We thought that term was appropriate because it suggests that not all women have the same set of symptoms. There could be a collection of symptoms that some women might mention and some might not. Syndrome connotes something more fluid and flexible.
We plan to use that term going forward if it is acceptable to other groups.
Nonhormonal treatments
This year also was remarkable because three new therapies were approved for menopausal symptoms. First, ospemifene (Osphena, Shionogi Inc.), an oral tablet that provides an estrogen alternative, was approved for dyspareunia.
Next, paroxetine (Brisdelle, Noven Therapeutics) was approved for treatment of vasomotor symptoms. It’s welcome news that this product was found to be effective at a lower dose than what is currently available for the treatment of depression.
Finally, conjugated estrogens/bazedoxifene (Duavee, Pfizer) is an exciting new concept in hormone therapy that will be interesting to watch. We are hopeful that there will be even more research forthcoming about whether it is also protective against breast cancer.
We now have a selection of hormonal and nonhormonal prescription therapies that can help women with all of the symptoms associated with menopause, but there is always a need for more information. In the coming year, we hope to see more research on over-the-counter treatments used for vaginal dryness — we need to know the incidence of contact dermatitis and other side effects of these products. We also look forward to publications from the KEEPS and ELITE trials.
Disclosure: Gass is the executive director of NAMS and a consultant at the Cleveland Clinic.