National Guideline Clearinghouse | Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society.
The North American Menopause Society
March 10, 2014
Guideline Title
Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society.
Bibliographic Source(s)
| Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society. Menopause. 2013 Sep;20(9):888-902. [149 references] PubMed  |
Guideline Status
This is the current release of the guideline.
This guideline updates a previous version: The North American
Menopause Society. The role of local vaginal estrogen for treatment of
vaginal atrophy in postmenopausal women: 2007 position statement of The
North American Menopause Society. Menopause. 2007 May-Jun;14(3 Pt
1):355-69; quiz 370-1.
update and expand the previous position statement of The North American
Menopause Society (NAMS) on the management of symptomatic vulvovaginal
atrophy (VVA) in postmenopausal women.
searched PubMed for medical literature on VVA published since their 2007
position statement on the role of local vaginal estrogen for treatment
of vaginal atrophy in postmenopausal women. A panel of acknowledged
experts in the field of genitourinary health reviewed the literature to
evaluate new evidence on local estrogen as well as on other management
options available or in development for symptomatic VVA. The panel's
conclusions and recommendations were reviewed and approved by the NAMS
Board of Trustees.
significantly impair the quality of life (QOL) of postmenopausal women
and may be underdiagnosed. In most cases, it can be managed
successfully. A number of over-the-counter and government-approved
prescription therapies available in the United States and Canada
demonstrate effectiveness, depending on the severity of VVA symptoms.
These include vaginal lubricants and moisturizers, vaginal estrogen,
hormone therapy, and the selective estrogen-receptor modulator
ospemifene (indicated for dyspareunia). Long-term studies on the
endometrial safety of local estrogen and ospemifene are lacking. Changes
in the vaginal microbiome have various effects on symptoms.
can improve the sexual health and QOL of postmenopausal women by
educating women about, diagnosing, and appropriately managing
symptomatic VVA. Choice of therapy depends on the severity of symptoms,
the effectiveness and safety of therapy for the individual patient, and
patient preference. Estrogen therapy is the most effective treatment for
moderate to severe symptoms, although a direct comparison of estrogen
and ospemifene is not available. Nonhormonal therapies available without
a prescription provide sufficient relief for most women with mild
symptoms. When low-dose estrogen is administered locally, a progestogen
is not indicated for women without a uterus and generally is not
indicated for women with an intact uterus. However, endometrial safety
has not been studied in clinical trials beyond 1 year. There are
insufficient data to confirm the safety of local estrogen in women with
breast cancer; management of VVA should take the woman's needs and the
recommendation of her oncologist into consideration. Research on the
vaginal microbiome may lead to other therapies in the future.
This guideline updates a previous version: The North American
Menopause Society. The role of local vaginal estrogen for treatment of
vaginal atrophy in postmenopausal women: 2007 position statement of The
North American Menopause Society. Menopause. 2007 May-Jun;14(3 Pt
1):355-69; quiz 370-1.
Menopause. 2013 Sep;20(9):888-902; quiz 903-4. doi: 10.1097/GME.0b013e3182a122c2.
Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society.
[No authors listed]
Abstract
OBJECTIVE:
Toupdate and expand the previous position statement of The North American
Menopause Society (NAMS) on the management of symptomatic vulvovaginal
atrophy (VVA) in postmenopausal women.
METHODS:
NAMSsearched PubMed for medical literature on VVA published since their 2007
position statement on the role of local vaginal estrogen for treatment
of vaginal atrophy in postmenopausal women. A panel of acknowledged
experts in the field of genitourinary health reviewed the literature to
evaluate new evidence on local estrogen as well as on other management
options available or in development for symptomatic VVA. The panel's
conclusions and recommendations were reviewed and approved by the NAMS
Board of Trustees.
RESULTS:
Symptomatic VVA cansignificantly impair the quality of life (QOL) of postmenopausal women
and may be underdiagnosed. In most cases, it can be managed
successfully. A number of over-the-counter and government-approved
prescription therapies available in the United States and Canada
demonstrate effectiveness, depending on the severity of VVA symptoms.
These include vaginal lubricants and moisturizers, vaginal estrogen,
hormone therapy, and the selective estrogen-receptor modulator
ospemifene (indicated for dyspareunia). Long-term studies on the
endometrial safety of local estrogen and ospemifene are lacking. Changes
in the vaginal microbiome have various effects on symptoms.
CONCLUSIONS:
Clinicianscan improve the sexual health and QOL of postmenopausal women by
educating women about, diagnosing, and appropriately managing
symptomatic VVA. Choice of therapy depends on the severity of symptoms,
the effectiveness and safety of therapy for the individual patient, and
patient preference. Estrogen therapy is the most effective treatment for
moderate to severe symptoms, although a direct comparison of estrogen
and ospemifene is not available. Nonhormonal therapies available without
a prescription provide sufficient relief for most women with mild
symptoms. When low-dose estrogen is administered locally, a progestogen
is not indicated for women without a uterus and generally is not
indicated for women with an intact uterus. However, endometrial safety
has not been studied in clinical trials beyond 1 year. There are
insufficient data to confirm the safety of local estrogen in women with
breast cancer; management of VVA should take the woman's needs and the
recommendation of her oncologist into consideration. Research on the
vaginal microbiome may lead to other therapies in the future.
- PMID:
- 23985562
- [PubMed - in process]
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