From the Guidelines
Vaginal atrophy in postmenopausal women can be treated with various options, including vaginal estrogen, vaginal androgens, and selective estrogen receptor modulators (SERMs) like ospemifene.
Treatment Options
- Vaginal Estrogen: is the most effective treatment for vaginal dryness leading to sexual dysfunction and has been shown to be effective in treating itching, discomfort, and painful intercourse in postmenopausal individuals 1.
- Vaginal Androgens (DHEA): can be considered for vaginal dryness or pain with sexual activity, and several studies have shown DHEA to be effective at reducing dyspareunia in postmenopausal individuals 1.
- Ospemifene: a selective estrogen receptor modulator (SERM), has been studied in several large trials of individuals with postmenopausal vulvar and vaginal atrophy and was found to effectively treat vaginal dryness and dyspareunia 1.
Additional Interventions
- Lubricants and Moisturizers: can be used to improve vulvovaginal tissue quality and alleviate symptoms such as vaginal dryness and sexual pain 1.
- Vaginal Dilators: may be of benefit in the management of vaginismus and/or vaginal stenosis and can be offered to anyone having pain with examinations and/or sexual activity 1.
- Pelvic Floor Physiotherapy: may be beneficial for patients experiencing symptoms of a potential pelvic floor dysfunction, including persistent pain and urinary and/or fecal leakage 1.
- Cognitive Behavioral Therapy (CBT): and pelvic floor (Kegel) exercises may be useful to decrease anxiety and discomfort and can lower urinary tract symptoms 1. It is essential to discuss the risks and benefits of each treatment option with the patient, especially for those with a history of hormone-dependent cancers 1.
From the Research
Treatment Options for Vaginal Atrophy in Postmenopausal Women
- Localized estrogen therapy is a common treatment option for vaginal atrophy in postmenopausal women, available in various forms such as creams, pessaries, tablets, and the estradiol-releasing ring 2
- Vaginal estrogen preparations with low systemic absorption rates, such as conjugated equine estrogens, estradiol vaginal cream, and a sustained-release intravaginal estradiol ring, may be preferred in women with a history of breast cancer and severe vaginal atrophy 3
- Non-hormonal therapies, such as vaginal lubricants and moisturizers, can also be effective in managing symptoms of vaginal atrophy and may be offered to women who wish to avoid the use of vaginal estrogens 3, 4
- Selective estrogen receptor modulators, such as lasofoxifene and ospemifene, have shown a positive impact on vaginal tissue in postmenopausal women, but further studies are needed to confirm their efficacy and safety 3
- Other emerging therapies, including vaginal dehydroepiandrostenedione, vaginal testosterone, and tissue-selective estrogen complexes, may also be effective in managing symptoms of vaginal atrophy, but require further research 3
Considerations for Treatment
- Clinicians should consider each woman's unique situation and health history before recommending a management strategy for vaginal atrophy 4
- Patient education and awareness about vaginal atrophy and its treatment options are crucial in addressing the condition effectively 5, 4
- Topical estrogen therapy remains the "golden standard" for treating post-menopausal vaginal atrophy, but alternatives such as non-hormonal therapies and emerging therapies may also be considered 6