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Skin, Mucosa and Menopause pp 229–235Cite as

Current and Emerging Treatment Options for Vulvovaginal Atrophy

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Abstract

Vulvovaginal atrophy in postmenopausal women is common and manifests in vaginal dryness, irritation, itching, dysuria, and dyspareunia. Treatment used to be limited to estrogen-containing regimens which pose safety concerns. Today, however, practitioners are becoming better equipped to offer a wider range of treatment options due to increased reassurance of safety for existing therapies and advances in novel treatment options. Novel options include selective estrogen receptor modulators (SERMs), tissue-selective estrogen complexes (TSECs), local androgens such as testosterone and dehydroepiandrosterone (DHEA), the peptide hormone oxytocin, as well as phytoestrogens such as genistein and daidzein found in soybeans. Nonhormonal, over-the-counter vaginal lubricants and moisturizers are additional treatment options, in particular, for women contraindicated to estrogen use.

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References

  1. North American Menopause Society. The role of local vaginal estrogen for the treatment of vaginal atrophy in postmenopausal women: 2007 position statement of The North American Menopause Society. Menopause. 2007;14:355–69.

    Article  Google Scholar 

  2. Calleja-Agius J, Brincat MP. Urogenital atrophy. Climacteric. 2009;12(4):279–85.

    Article  CAS  PubMed  Google Scholar 

  3. North American Menopause Society. Estrogen and progestogen use in postmenopausal women: 2010 position statement of the North American Menopause Society. Menopause. 2010;17(2):242–55.

    Article  Google Scholar 

  4. North American Menopause Society. The 2012 hormone therapy position statement of: The North American Menopause Society. Menopause. 2012;19(3):257–71.

    Google Scholar 

  5. Nachtigall L, Nachigall M, Goren J, Loweenstein J. Update on vaginal atrophy. Menopause Manag. 2005;14:17–9.

    Google Scholar 

  6. Castelo-Branco C, Cancelo MJ, Villero J, Nohales F, Julia MD. Management of post-menopausal vaginal atrophy and atrophic vaginitis. Maturitas. 2005;52:S46–52.

    Article  PubMed  Google Scholar 

  7. Goldstein I, Alexander JL. Practical aspects in the management of vaginal atrophy and sexual dysfunction in perimenopausal and postmenopausal women. J Sex Med. 2005;2 Suppl 3:154–65.

    Article  PubMed  Google Scholar 

  8. Bachmann G, Nevadunsky N. Diagnosis and treatment of atrophic vaginitis. Am Fam Physician. 2000;61:3090–6.

    CAS  PubMed  Google Scholar 

  9. Long CY, Liu CM, Hsu SC, Wu CH, Wang CL, Tsai EM. A randomized comparative study of the effects of oral and topical estrogen therapy on the vaginal vascularization and sexual function in hysterectomized postmenopausal women. Menopause. 2006;13:727–43.

    Article  Google Scholar 

  10. 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. 2009;112:1053–60.

    Article  Google Scholar 

  11. Al-Baghdadi O, Ewies AA. Topical estrogen therapy in the management of postmenopausal vaginal atrophy: an up-to-date overview. Climacteric. 2009;12:91–105.

    Article  CAS  PubMed  Google Scholar 

  12. Goldstein I. Hormonal factors in women’s sexual pain disorders. In: Goldstein A, Pukall C, Goldstein I, editors. Female sexual pain disorders: evaluation and management. Blackwell-Wiley; Chichester, 2009. p. 180–95.

    Google Scholar 

  13. Barentsen R, van de Weijer PHM, Schram JHN. Continuous low dose estradiol released from a vaginal ring versus estriol vaginal cream for urogenital atrophy. Eur J Obstet Gynecol Reprod Biol. 1997;71:73–80.

    Article  CAS  PubMed  Google Scholar 

  14. Cano A, Estevez J, Usandizaga R, Gallo JL, Guinot M, Delgado JL, et al. The therapeutic effect of a new ultra low concentration estriol gel formulation (0.005% estriol vaginal gel) on symptoms and signs of postmenopausal vaginal atrophy: results from a pivotal phase III study. Menopause. 2012;19(10):1130–9.

    Article  PubMed  Google Scholar 

  15. Suckling J, Lethaby A, Kennedy R. Local estrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev. 2006;4:CD001500.

    PubMed  Google Scholar 

  16. Ibe C, Simon JA. Vulvovaginal atrophy: current and future therapies. J Sex Med. 2010;7:1042–50.

    Article  PubMed  Google Scholar 

  17. Johnston SL, Farrell SA, Bouchard C, Farrell SA, Beckerson LA, Comeau M, et al. The detection and management of vaginal atrophy. J Obstet Gynaecol Can. 2004;26:503–15.

    PubMed  Google Scholar 

  18. Shelly W, Draper MW, Krishnan V, Wong M, Jaffe RB. Selective estrogen receptor modulators: an update on recent clinical findings. Obstet Gynecol Surv. 2008;63:163–81.

    PubMed  Google Scholar 

  19. Wurz GT, Soe LH, DeGregorio MW. Ospemifene, vulvovaginal atrophy, and breast cancer. Maturitas. 2013;74:220–5.

    Article  CAS  PubMed  Google Scholar 

  20. Pickar JH. Emerging therapies for postmenopausal vaginal atrophy. Maturitas. 2013;75:3–6.

    Article  CAS  PubMed  Google Scholar 

  21. Bachmann GA, Komi JO. Ospemifene effectively treats vulvovaginal atrophy in postmenopausal women: results from a pivotal phase 3 study. Menopause. 2010;17:480–6.

    PubMed  Google Scholar 

  22. Goldstein SR, Cummings SR, Eastell R, Ensrud K, Tan O, Bradshaw K, et al. Vaginal effects of lasofoxifene: 3-year results from the PEARL trial. Menopause. 2008;15:1228.

    Article  Google Scholar 

  23. Goldstein SR, Neven P, Cummings S, Colgan T, Runowicz CD, Krpan D, et al. Postmenopausal evaluation and risk reduction with Lasofoxifene (PEARL) trial: 5-year gynecological outcomes. Menopause. 2011;18(1):17–22.

    Article  PubMed  Google Scholar 

  24. Tan O, Bradshaw K, Carr BR. Management of vulvovaginal atrophy-related sexual dysfunction in postmenopausal women: an up-to-date review. Menopause. 2012;19(1):109–17.

    Article  PubMed  Google Scholar 

  25. Archer DR. Tissue-selective estrogen complexes: a promising option for the comprehensive management of postmenopausal symptoms. Drugs Aging. 2010;27:533–44.

    Article  CAS  PubMed  Google Scholar 

  26. Lobo RA, Pinkerton JV, Gass ML, Dorin MH, Ronkin S, Pickar JH, et al. Evaluation of bazedoxifene/conjugated estrogens for the treatment of menopausal symptoms and effects on metabolic parameters and overall safety profile. Fertil Steril. 2009;92:1025–38.

    Article  CAS  PubMed  Google Scholar 

  27. Pickar JH, Yeh IT, Bachmann G, Speroff L. Endometrial effects of a tissue-selective estrogen complex containing bazedoxifene/conjugated estrogens as a menopausal therapy. Fertil Steril. 2009;92:1018–24.

    Article  CAS  PubMed  Google Scholar 

  28. Kagan R, Williams RS, Pan K, Mirkin S, Pickar JH. A randomized, placebo- and active-controlled trial of bazedoxifene/conjugated estrogens for treatment of moderate to severe vulvar/vaginal atrophy in postmenopausal women. Menopause. 2010;17(2):281–9.

    Article  PubMed  Google Scholar 

  29. Berman JR, Almeida FG, Jolin J, Raz S, Chaudhuri G, Gonzalez-Cadavid NF. Correlation of androgen receptors, aromatase and 5-alpha reductase in the human vagina with menopausal status. Fertil Steril. 2003;79:925–31.

    Article  PubMed  Google Scholar 

  30. Traish AM, Kim N, Min K, Muarriz R, Goldstein I. Role of androgens in female genital sexual arousal: receptor expression, structure and function. Fertil Steril. 2002;77(4):S11–8.

    Article  PubMed  Google Scholar 

  31. Baldassarre M, Perrone AM, Giannone FA, Armillotta F, Battaglia C, Costantino A, et al. Androgen receptor expression in the human vagina under different physiological and treatment conditions. Int J Impot Res. 2013;25:7–11.

    Article  CAS  PubMed  Google Scholar 

  32. Witherby S, Johnson J, Demers L, Mount S, Littenberg B, Maclean CD, et al. Topical testosterone for breast cancer patients with vaginal atrophy related to aromatase inhibitors: a phase I/II study. Oncologist. 2011;16:424–31.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. Labrie F, Cusan L, Gomez JL, Côté I, Bérubé R, Bélanger P, et al. Effect of intravaginal DHEA on serum DHEA and eleven of its metabolites in postmenopausal women. J Steroid Biochem Mol Biol. 2008;111:178–94.

    Article  CAS  PubMed  Google Scholar 

  34. Labrie F, Archer D, Bouchard C, Fortier M, Cusan L, Gomez JL, et al. Effect of intravaginal dehydroepiandrosterone (prasterone) on libido and sexual function in postmenopausal women. Menopause. 2009;16(5):923–31.

    Article  PubMed  Google Scholar 

  35. Labrie F, Archer D, Bouchard C, Fortier M, Cusan L, Gomez JL, et al. Intravaginal dehydroepiandrosterone (prasterone), a highly efficient treatment of dyspareunia. Climacteric. 2011;14:282–8.

    Article  CAS  PubMed  Google Scholar 

  36. Jonasson AF, Edwall L, Uvnas-Moberg K. Topical oxytocin reverses vaginal atrophy in postmenopausal women: a double-blind randomized pilot study. Menopause Int. 2011;17:120–5.

    PubMed  Google Scholar 

  37. Bedell S, Nachtigall M, Naftolin F. The pros and cons of plant estrogens for menopause. J Steroid Biochem Mol Biol. 2013 (in press). Available at: http://www.sciencedirect.com/science/journal/aip/09600760. Accessed 11 Nov 2013.

  38. Le Donne M, Caruso C, Manscuso A, Costa G, Iemmo R, Pizzimenti G, et al. The effect of vaginally administered genistein in comparison with hyaluronic acid on atrophic epithelium in postmenopause. Arch Gynecol Obstet. 2011;283:1319–23.

    Article  CAS  PubMed  Google Scholar 

  39. Lima SM, Yamada SS, Reis BF, Sostenes P, Postigo S, Galvão da Silva MA, Aoki T. Effective treatment of vaginal atrophy with isoflavone vaginal gel. Maturitas. 2013;74(3):252–8.

    Article  CAS  PubMed  Google Scholar 

  40. Stika CS. Atrophic vaginitis. Dermatol Ther. 2010;23:514–22.

    Article  PubMed  Google Scholar 

  41. Sinha A, Ewies AA. Non-hormonal topical treatment of vulvovaginal atrophy: an up-to-date overview. Climacteric. 2013;16(3):305–12.

    Article  CAS  PubMed  Google Scholar 

  42. Nachtigall LE. Comparative study: Replens versus local estrogen in menopausal women. Fertil Steril. 1994;61:178–80.

    CAS  PubMed  Google Scholar 

  43. Bygdeman M, Swahn ML. Replens versus dienoestrol cream in the symptomatic treatment of vaginal atrophy in postmenopausal women. Maturitas. 1996;23(3):259–63.

    Article  CAS  PubMed  Google Scholar 

  44. Van der Laak JA, de Bie LM, de Leeuw H, de Wilde PC, Hanselaar AG. The effects of Replens on vaginal cytology in the treatment of postmenopausal atrophy: cytomorphology versus computerized cytometry. J Clin Pathol. 2002;55(6):446–51.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Chen J, Geng L, Song X, Li H, Giordan N, Liao Q. Evaluation of the efficacy and safety of hyaluronic acid vaginal gel to ease vaginal dryness: a multicenter, randomized, controlled, open-label, parallel-group, clinical trial. J Sex Med. 2013;10(6):1575–84.

    Article  CAS  PubMed  Google Scholar 

  46. Donders GG, Bellen G. Cream with cutaneous fibroblast lysate for the treatment of provoked vestibulodynia: a double-blind randomized placebo-controlled crossover study. J Low Genit Tract Dis. 2012;16(4):427–36.

    Article  PubMed  Google Scholar 

  47. Burrows LJ, Basha M, Goldstein AT. The effects of hormonal contraceptives on female sexuality: a review. J Sex Med. 2012;9(9):2213–23.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, George Washington University, Washington, DC, USA

    Jill M. Krapf

  2. Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA

    Zoe Belkin

  3. NEOGYN Inc., 101 Hudson Street, Jersey City, NJ, 07302, USA

    Frank Dreher

  4. Department of Obstetrics and Gynecology, Center for Vulvovaginal Diseases, Washington, DC, USA

    Andrew T. Goldstein MD

Authors
  1. Jill M. Krapf
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  2. Zoe Belkin
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  3. Frank Dreher
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  4. Andrew T. Goldstein MD
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Corresponding author

Correspondence to Frank Dreher .

Editor information

Editors and Affiliations

  1. Procter & Gamble Co., Cincinnati, Ohio, USA

    Miranda A. Farage

  2. Procter & Gamble Co., Cincinnati, Ohio, USA

    Kenneth W. Miller

  3. School of Nursing, University of Washington, Seattle, Washington, USA

    Nancy Fugate Woods

  4. Department of Dermatology, University of California School of Medicine, San Francisco, California, USA

    Howard I. Maibach

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Krapf, J.M., Belkin, Z., Dreher, F., Goldstein, A.T. (2015). Current and Emerging Treatment Options for Vulvovaginal Atrophy. In: Farage, M., Miller, K., Fugate Woods, N., Maibach, H. (eds) Skin, Mucosa and Menopause. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-44080-3_18

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  • DOI: https://doi.org/10.1007/978-3-662-44080-3_18

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-44079-7

  • Online ISBN: 978-3-662-44080-3

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