A Dermatologist’s Approach to Genitourinary Syndrome of Menopause

2017 ◽  
Vol 21 (5) ◽  
pp. 418-424 ◽  
Author(s):  
Matthew Hum ◽  
Marlene Dytoc
Keyword(s):  
Estrogen Therapy ◽  
Rapid Onset ◽  
High Dose ◽  
Papanicolaou Test ◽  
Genitourinary Syndrome Of Menopause ◽  
Vaginal Estrogen ◽  
Proven Efficacy ◽  
Conjugated Equine Estrogens ◽  
Vaginal Estrogen Therapy ◽  
Genitourinary Syndrome

Background: Genitourinary syndrome of menopause (GSM) is a debilitating condition caused by hypoestrogenism that presents with vaginal dryness and dyspareunia as well as other genital, sexual, and urinary symptoms. Previously known as atrophic vaginitis, the term GSM is now used. Objective: To help familiarise dermatologists with diagnosing and managing GSM. Methods: In total, 218 articles were identified and reviewed by 2 independent authors using PubMed. Articles included were from December 2005 to December 2015. Sixty-seven articles met our inclusion criteria. Results: GSM is a clinical diagnosis, requiring the presence of symptoms that should be bothersome and not accounted for by another condition. A pH test may help with diagnosis as vaginal pH will be increased from acidic to neutral. The Papanicolaou test is not recommended because of poor clinical correlation. First-line treatment is low-dose local vaginal estrogen therapy, which has proven efficacy and safety. Serum estrogen levels are not significantly affected with the exception of creams containing high-dose conjugated equine estrogens. Other options have yet to be approved for use in Canada but show promise. Conclusion: GSM is a debilitating and common condition that suffers from barriers to diagnosis and treatment. Current treatments are well tolerated, rewarding, and effective with rapid onset.

A randomized clinical trial comparing vaginal laser therapy to vaginal estrogen therapy in women with genitourinary syndrome of menopause

Menopause ◽  
2020 ◽  
Vol 27 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Marie Fidela R. Paraiso ◽  
Cecile A. Ferrando ◽  
Eric R. Sokol ◽  
Charles R. Rardin ◽  
Catherine A. Matthews ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Laser Therapy ◽  
Estrogen Therapy ◽  
Genitourinary Syndrome Of Menopause ◽  
Vaginal Estrogen ◽  
Vaginal Estrogen Therapy ◽  
Genitourinary Syndrome

scholarly journals Managing Genitourinary Syndrome of Menopause in Breast Cancer Survivors Receiving Endocrine Therapy

2019 ◽  
Vol 15 (7) ◽  
pp. 363-370 ◽  
Author(s):  
Tamara A. Sussman ◽  
Megan L. Kruse ◽  
Holly L. Thacker ◽  
Jame Abraham
Keyword(s):  
Breast Cancer ◽  
Hormonal Therapy ◽  
Breast Cancer Survivors ◽  
Estrogen Therapy ◽  
Fear Of Cancer Recurrence ◽  
Systemic Absorption ◽  
Genitourinary Syndrome Of Menopause ◽  
Vaginal Estrogen ◽  
Vaginal Estrogen Therapy ◽  
Genitourinary Syndrome

Patients with breast cancer receiving antiestrogen therapy, specifically aromatase inhibitors, often suffer from vaginal dryness, itching, irritation, dyspareunia, and dysuria, collectively known as genitourinary syndrome of menopause (GSM). GSM can decrease quality of life and is undertreated by oncologists because of fear of cancer recurrence, specifically when considering treatment with vaginal estrogen therapy because of unknown levels of systemic absorption of estradiol. In this article, we review the available literature for treatment of GSM in patients with breast cancer and survivors, including nonhormonal, vaginal hormonal, and systemic hormonal therapy options. First-line treatment includes nonhormonal therapy with vaginal moisturizers, lubricants, and gels. Although initial studies showed significant improvement in symptoms, the US Food and Drug Administration recently issued a warning against CO2 laser therapy for treatment of GSM until additional studies are conducted. In severe or refractory GSM, after discussing risks and benefits of vaginal hormonal therapy, the low-dose 10-μg estradiol-releasing intravaginal tablet or lower-dose 4 μg estrogen vaginal insert and intravaginal dehydroepiandrosterone (prasterone) are options for treatment, because studies show minimal elevation in serum estradiol levels and significant improvement in symptoms. The decision to offer vaginal estrogen therapy must be individualized and made jointly with the patient and her oncologist.

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