Women using low-dose vaginal estrogen tablets and rings have a very small increase in serum estradiol levels that remains well within the normal postmenopausal range.Multiple studies have investigated the endometrial safety of vaginal estrogen, including two randomized controlled trials (RCTs) that documented no difference in endometrial hyperplasia or cancer with endometrial biopsy samples after 12 months of vaginal estrogen exposure.The packaging for vaginal estrogen includes the same information as for systemic estrogen. Options include lifestyle changes and non-hormonal and hormonal treatments. Few studies have demonstrated vaginal estrogen safety in breast cancer patients. Although these agents are often effective, their high osmolality can theoretically dehydrate the adjacent vaginal epithelium and cause irritation.The gold standard pharmacologic treatment for GSM is still vaginal estrogen, especially for patients who are not suffering from systemic symptoms of menopause. endstream
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Only about one-quarter of women ever discuss their symptoms with a provider. Prasterone likely works by local conversion of androstenedione and testosterone into estrone and estradiol. Vaginal lasers marketed for GSM have also recently arrived on the market. Frequently, the burden falls on the patient to initiate the conversation.The primary goal of GSM treatment is symptom relief. One prospective cohort study followed 69 women with a history of breast cancer who used vaginal estrogen for an average of one year. Natural menopause or oophorectomy. Treatment should always start non-pharmacologically with topical moisturizers and lubricants. %%EOF
Genitourinary syndrome of menopause is a condition comprising the atrophic symptoms and signs women may experience in the vulvovaginal and bladder-urethral areas as a result of the loss of sex steroids that occurs with menopause. Physiologically, this manifests with symptoms of vaginal dryness, vaginal irritation, vaginal itching and may affect sexual function due to dyspareunia and diminished lubrication (Table 1). Moisturizers commonly contain molecules that are capable of retaining large amounts of water and releasing them slowly. For a variety of reasons, many … Certain brands are markedly hyperosmolar, such as Astroglide, KY Jelly, and Replens. The need for more long-term data on prasterone prohibits us from recommending it as a treatment option at this time. Genitourinary syndrome of menopause (GSM) is a relatively new term that describes the constellation of lower urogenital tract signs and symptoms associated with a low-estrogen state. Management of genitourinary syndrome of menopause in women with or at high risk for breast cancer: consensus recommendations from The North American Menopause Society and The International Society for the Study of Women’s Sexual Health . Genitourinary syndrome of menopause is a fairly new term. 1 The recent change in terminology originated with a consensus panel comprising the board of directors of the International Society for the Study of Women’s Sexual Health (ISSWSH) and the board of trustees of the North American Menopause Society (NAMS). Patients taking systemic estrogen may still suffer from GSM and could benefit from additional vaginal estrogen therapy. Ospemifene is an alternative prescription option for GSM that is approved by the FDA and may be a good option for patients with a history of breast cancer or who want to avoid estrogen, however, it may increase hot flashes and requires daily oral dosing. In RCTs, prasterone has been shown to decrease dyspareunia compared to placebo in postmenopausal women.Though there have not been head-to-head trials comparing ospemifene or prasterone against vaginal estrogen, the efficacy of vaginal estrogen has been well demonstrated and its safety profile is far lengthier than that of the current alternatives. Surveys have shown that 45% to 63% of postmenopausal women have experienced vulvovaginal symptoms, most commonly vaginal dryness. h�bbd``b`�A@�i����q� ���:"� FE��`� �*@Bx��$�����0&F��������d{ � ���
Genitourinary syndrome of menopause (GSM) is a con-stellation of physical changes and symptoms including vul-vovaginal dryness, burning, or irritation; dyspareunia; and urinary symptoms of urgency, dysuria, or recurrent urinary tract infection (UTI) associated with estrogen deficiency.2 Although GSM affects more than 50% of the general popula-