EXECUTIVE SUMMARY

Results of a new study involving more than 1,500 postmenopausal women indicate that patients still are not comfortable in proactively discussing vaginal issues related to menopause with their healthcare providers.

• In the new study, 45% of women reported some type of postmenopausal vulvovaginal symptom, such as vaginal dryness, itching, soreness, or odor. However, only 39% of symptomatic women discussed their symptoms at well woman visits.

• When conversations about vulvovaginal health did occur, researchers report it usually was the patient who initiated the discussion, rather than the clinician.


Results of a new study involving more than 1,500 postmenopausal women indicate that patients still are not comfortable in proactively discussing vaginal issues related to menopause with their healthcare providers.1

Genitourinary syndrome of menopause (GSM) is defined as the signs and symptoms associated with a decrease in estrogen and other sex steroids involving changes to the labia majora/minora, clitoris, vestibule/introitus, vagina, urethra, and bladder. Women may report genital symptoms of dryness, burning, and irritation; sexual symptoms of lack of lubrication, discomfort or pain, and impaired sexual function; and urinary symptoms of urgency, dysuria, and recurrent urinary tract infections.2 Low-dose vaginal estrogen and ospemifene provide effective therapy for the such symptoms, and vaginal moisturizers and lubricants are available for those who do not choose hormonal therapy.3

In the new study, 45% of women reported some type of postmenopausal vulvovaginal symptom, such as vaginal dryness, itching, soreness, or odor. However, only 39% of symptomatic women discussed their symptoms at their well woman visits. When conversations about vulvovaginal health did occur, researchers report it often was the patient who initiated the discussion, rather than the clinician (59% vs. 22%).1

“Nearly half of these postmenopausal women reported having a vulvovaginal problem, yet a minority discussed their symptoms at a well woman visit,” said Amanda Clark, MD, MCR, lead author of the study and an affiliate investigator with the Kaiser Permanente Center for Health Research in Portland, in a statement. “Since the discussions that did occur led to helpful interventions, this suggests a role for greater clinician-initiated screening for genitourinary syndrome of menopause.” 4

It is time to talk with women about symptoms. In a 2016 study, researchers recruited women ages 55 and older from primary care offices and senior centers for survey on common symptoms after menopause. Participants reported that the most common symptoms were itching, burning, stinging, pain, irritation, dryness, discharge, or odor. Fifty-one percent said they experience one or more of these symptoms, 40% of women said symptoms posed emotional problems, and 33% said they had an effect on their lifestyle.5

Ask About Symptoms

During menopause, estrogen deficiency can lead to thinning of the vaginal epithelium. As a result, women may encounter vaginal dryness, itching, dyspareunia, and urinary symptoms. In a study that analyzed data from more than 2,400 women over a 17-year-period who were enrolled in the Study of Women’s Health Across the Nation, at baseline, 19.4% of women, ages 42-53, reported vaginal dryness. In the same study, by the time women reached ages 57-69, 34% of them complained of symptoms.6

The effects of GSM can prevent postmenopausal women from having or enjoying sex. Lubricants and vaginal moisturizers are nonhormonal options. Other therapies include vaginal estrogen tablets, creams, vaginal ring, and intravaginal dehydroandrosterone. In 2016, the FDA approved Intrarosa to treat women experiencing moderate to severe pain during sexual intercourse due to menopause. Intrarosa contains the active ingredient prasterone, also known as dehydroepiandrosterone (DHEA).

Data indicate that low-dose tablets, the vaginal ring, and creams have comparable efficacy in treating vulvovaginal symptoms.7 Research suggests that vaginal estradiol may reduce the risk of recurrent urinary tract infections and overactive bladder symptoms in menopausal women.8 The low-dose vaginal ring is approved to treat urinary urgency and dysuria.3 A systematic review that evaluated current evidence for the efficacy and safety of vaginal estrogen products for GSM treatment concluded that commercially available vaginal estrogen therapies are safe and effective first-line options for treating moderate to severe GSM.9

“With so many options now available, such as over-the-counter lubricants and moisturizers as well as low dose vaginal hormonal products containing estrogen or DHEA, there is no reason for women to continue to suffer in silence,” said Stephanie Faubion, MD, MBA, medical director of the North American Menopause Society, in a statement. “Hopefully, studies like this one will open the door to better patient-provider communication at well woman visits.”4

REFERENCES

  1. Clark AL, Bulkley JE, Bennett AT, et al. Discussion of vulvovaginal health at postmenopausal well woman visit — patient characteristics and visit experiences. Presented at the 2019 North American Menopause Society Annual Meeting, Chicago, September 2019.
  2. Shifren JL, Gass ML; NAMS Recommendations for Clinical Care of Midlife Women Working Group. The North American Menopause Society recommendations for clinical care of midlife women. Menopause 2014;21:1038-1062.
  3. Stuenkel CA, Davis SR, Gompel A, et al. Treatment of symptoms of the menopause: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2015;100:3975-4011.
  4. North American Menopause Society. More discussion needed about vulvovaginal health at well woman visits. Sept. 24, 2019. Available at: https://bit.ly/2mqlcnO.
  5. Erekson EA, Li FY, Martin DK, et al. Vulvovaginal symptoms prevalence in postmenopausal women and relationship to other menopausal symptoms and pelvic floor disorders. Menopause 2016;23:368-375.
  6. 6. Waetjen LE, Crawford SL, Chang PY, et al. Factors associated with developing vaginal dryness symptoms in women transitioning through menopause: A longitudinal study. Menopause 2018;25:1094-1104.
  7. 7. Rahn DD, Carberry C, Sanses TV, et al. Vaginal estrogen for genitourinary syndrome of menopause: A systematic review. Obstet Gynecol 2014;124:1147-1156.
  8. 8. Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society. Menopause 2013;20:888-902.
  9. 9. Biehl C, Plotsker O, Mirkin S. A systematic review of the efficacy and safety of vaginal estrogen products for the treatment of genitourinary syndrome of menopause. Menopause 2019;26:431-453.