Vulvovaginal atrophy, now known as the genitourinary syndrome of menopause (GSM), occurs with the decline of estrogen in the menopausal period. As with many clinical conditions, the spectrum of GSM requires the clinician to consider the effect on the patient’s quality of life. Although many symptoms are pacified effectively with situational lubricants and regular moisturizers, local estrogen is a safe, effective, and affordable way to treat the vulvovaginal changes of menopause.
Recommendations for menopausal hormone therapy were widely publicized and adopted following the original publication of the results of the Women’s Health Initiative and affected both initiation and continuation of estrogen therapy through at least 2013.
The Food and Drug Administration recently approved two new modalities to aid in menopause management: MenoCheck, a diagnostic tool to show a woman’s menopausal status, and Bijuva, a medication to help with hot flashes.
Sexual function often decreases for women because of the genitourinary syndrome of menopause (GSM). This condition includes the physical changes of the vulva, vagina, and lower urinary tract that result from estrogen deficiency.
Data from a large longitudinal study indicate that more than 33% of women ages 57-69 report symptoms of vaginal dryness. However, research shows that more than 50% of women don’t report such conditions to their healthcare providers. Even fewer women take advantage of proven therapies such as vaginal estrogen tablets, creams, and rings.
A larger epidemiologic study from Norway found no association between early menarche and age of menopause. Women with early menarche experience a longer fertility window, which may increase certain risks.
In this 12-week randomized, controlled trial of 302 women, neither vaginal estrogen nor vaginal moisturizer was more effective than placebo for reducing the participants’ most bothersome symptom (pain with vaginal penetration, vulvovaginal itching, vulvovaginal pain, vaginal dryness, or vulvovaginal irritation).
The U.S. Preventive Services Task Force has issued a final recommendation statement and evidence summary upholding its earlier recommendation against use of hormone therapy for the primary prevention of chronic conditions in postmenopausal women.