vaginal dryness cim
TRANSCRIPT
A REAL NEED:Vaginal Moisturizers for
Urogenital Atrophy
Ma Virginia M Santos-Abalos MD FPOGS FPSGE
Professor, Cebu Institute of Medicine, CDU College of Medicine
Advisory Board / SpeakerAbbott Solvay
Bayer Philippines
Biofemme
Glaxo Smith Kline
MSD Philippines
Nycomed
Disclosure
FACTSThreats to normal vaginal health at any stage of a woman’s life
Altered Vaginal Health
1 Increased risk for infections (BV)
2 Likelihood of adverse pregnancy outcome
3 Poor quality of life in the peri- and menopausal years, and during chemotherapy for breast CA
4 Impaired sexual function
3 Poor quality of life in the peri- and menopausal years, and during chemotherapy for breast CA
4 Impaired sexual function
GENITOURINARY Tract
Embryologically and anatomically in close proximity
Presence of estrogen receptors in the mucosa
Pathophysiology in one produces symptoms in adjacent organ
Discussion Points
Burden of the disease
Estrogen and vaginal health
Practical management options for women presenting with ‘vaginal dryness’
Burden of the Disease
How common is vaginal dryness?
Does this cause significant suffering?
Vulvovaginal Atrophy can occur at any time in a woman’s life cycle
Hypoestrogenic state
Postmenopause
Lactation
Hypothalamic amenorrhea
Various breast cancer treatments
Drug-induced Certain medications e.g antihistamines
Postmenopause
Various breast cancer treatments
Prevalence of superficial dyspareuniaand vulvovaginal atrophy by menopausal age
Adapted from Versi E, et al. Int Urogynecol J 2001;12:107–10
Perimenopause(n = 133)
0–1 year(n = 52)
2–3 years(n = 39)
4 years(n = 67)
Atrophy increased significantly with increase in menopausal age (p <0 .001)
Vaginal dryness with menopause
Dennerstein L, et al. Obstet Gynecol 2000;96:351–8
Pre-menopause
(n = 172)
Earlyperimenopause
(n = 148)
Lateperimenopause
(n = 106)
Post-menopause
1 year(n = 72)
Post-menopause
2 years(n = 54)
Post-menopause
3 years(n = 31)
3%
47%
21%
25%
32%
4%
Dryness increased significantly in late perimenopause and postmenopause (p <0 .001)
Lower estrogen levels are associatedwith increased prevalence of sexual problems
0
10
20
30
40
50
60
Vaginal dryness
Bothered by problem
Dyspareunia (intensity)
Pain with penetration
Burning
% R
epo
rtin
g p
rob
lem
s
<184 pmol/l (50pg/ml) estradiol
>184 pmol/l (50pg/ml) estradiol
Sarrel PM. J Womens Health Gend Based Med 2000;9:S25–32
Adapted from Sarrel PM. Obstet Gynecol 1990;75(4 Suppl):26–30SSantiago Palacios. MATURITAS 63 (2009) 315-318
n = 93; significance not reported
VAGINAL ATROPHY: Symptoms Santiago Palacios. MATURITAS 63 (2009) 315-318
Vaginal dryness
Bothered by problem
DyspareuniaPain with
penetrationBurning
• Up to 40% of postmenopausal women experience vaginal atrophy
• Only 25% of them seek medical assistance
Prevalence of vaginal atrophy
Bachman GA, et al. Am Fam Physician 2000;61:3090–6Cardozo L, et al. Obstet Gynecol 1998;92:722–7
Estrogen Deficiency: SYMPTOMS
Short term
Menstrual irregularitiesVasomotor disturbancesHot flushes, sweats, palpitationsIrritability, mood swingsFatigue, depression
Medium term
Decreased libidoAtrophic vaginitisDyspareuniaUTI
Long term
Bone loss, osteoporotic fracturesCardiovascualr disease
Medium term
Decreased libidoAtrophic vaginitisDyspareuniaUTI
Unlike vasomotor symptoms, which typically resolve over time, vaginal atrophy remains a persistent consequence of the menopausal transition and frequently requires treatment
Vaginal Atrophy
International Menopause Society Writing Group. Recommendations for the management of postmenopausal vaginal atrophy. Climacteric. 2010
Prevalence of symptoms inwomen treated for breast cancer
Symptom Symptoms (%)
Moderate – severe (%)
Hot flushes/sweats 85 63
Sexual problems 60 45
Urinary problems 55 39
Vaginal dryness 55 34
Gupta P, et al. Climacteric 2006;9:49–58
Menopause Rating Scale; n = 200
Vaginal dryness 55 34
Sexual problems 60 45
Estrogen & Vaginal Health
Vaginal Cell Maturation
MI = 10/30/60
S
MP
I
Superficial
Intermediate
Parabasal
Metaplastic
10% Parabasal
30% Intermediate
60% Superficial
Estrogen
Döderlein's lactobacilli convert glycogenfrom sloughed vaginal cells
Lactic acid
Glycogen formation
Vaginal pH (3.5-4.5)
Protects from:Streptococcus
StaphylococcusColiform
Diphtheroid infections
Mucus layer
Maintains thickness
of squamous vaginal epithelium, rugae,
pink color, and moisture
Proliferation of connective tissueFragmentation of elastinHyalanization of collagen
Effects of estrogen on the vaginal epithelium
IMS Writing Group. Recommendations for the management of postmenopausal
vaginal atrophy. Climacteric. 2010
WELL-ESTROGENIZED VAGINA
Layers well-delineatedNormal Introitus
Gross Changes with Estrogen Loss Mehta A, Bachmann G. Vulvovaginal complaints. Clin Obstet Gynecol. 2008;51:549-555
Loss of labial and vulvar fullness
Pallor of urethral & vaginal epithelium
Minimal vaginal moisture
Loss of urethral meatal turgor Atrophy Of Labia Majora
Low Moisture Content
Estrogen and Physical Changes
Vaginal Atrophy Normal vulvovagina
ESTROGEN and Histologic changes
WELL-ESTROGENIZED ESTROGEN LOSS
NORMAMulti-layered w/ good blood supply Superficial cells rich in glycogen
Atrophy with marked thinning of the epithelium Reduced blood supply Loss of glycogen
Vaginal histology
Premenopause
Well-estrogenized epithelium, multi-layered with good blood supply; superficial cells rich in glycogen
Postmenopause
Estrogen-deficiency atrophy with marked thinning of the epithelium, reduced blood supply and loss of glycogen
H & E, magnification 10
Postmenopausal changesin the vaginal epithelium
Loss of folds Folds or rugae
Muscular coat
Erectile tissue
Inner lining contains large
amount glycogen
Loss of inner lining and glandular function
PREMENOPAUSAL POSTMENOPAUSAL
Samsioe G. A profile of the Menopause, 1995:49 (Figure 6.4)
Clinical Assessment of the Vagina Adapted with permission from Parsons A, et al. Obstet
Gynecol. 2003
DEGREE MILD MODERATE SEVERE
RUGAE Reduced Rare Smooth vagina
PALLOR Light pink Pale White / deep red
PETECCHIAE Rare Bleeds on scraping
Bleeds on contact
MUCOSAL ELASTICITY Decreased None Stenosis
DRYNESSSlightly decreased
Minimal Dry
VAGINAL pH >4.5 <5 5 & > >5
HORMONE CHANGES
Diabetes Oral Contraceptive Pills Aromatase Inhibitors (AI)ANTI-MICROBIALS
MENSES
SEMEN pH= 8
SOAP pH= 7-10
THREATS to the vaginal ecosystem
ESTROGEN
GLYCOGEN
LACTOBACILLI
LACTIC ACID
pH 3.8-4.5
Correlates with decreased risk for RTIs (Chlamydia and Trichomonas), as well as UTI. (Bosket et al. Infect Immuno 1999)
Increases lactobacilli ability to bind to the vaginal epithelium Reduces the activity of pathogenic bacterial enzymes such as ‘sialidase’. (Nagy et al. BJOG 1985)
Protective against BV, mycoplasma hominis, bacteroides;maximum attachment of Gardnerella to vaginal cells at alkaline pH 5-6. (Cauci et al. AJOG) (Sobel JD. BV., Annu Rev Med 2000)
Vaginal pH, predictor of status of vaginal ecosysytemAcid vaginal pH a protective mechanism for RTI, UTI
Vaginal ph and Maturation Index
Surrogate markers of vaginal health
ALTERED VAGINAL HEALTH, A FACT OF LIFE FOR EVERY WOMAN AT SOME POINT
Estrogen Therapy
Lifestyle & Behavioral modification
Non-Hormonal therapy
Management Options
Estrogen and Vaginal Atrophy
Research has shown that low-dose vaginal estrogen is effective and well tolerated for treating vaginal atrophy and has been shown to reduce vaginal symptoms, including dyspareunia and vaginal dryness, and to restore vaginal pH and normal vaginal cytology
Estrogen therapy reverses atrophy
Huang, Kaley. Gender-specific regulation of CV function: Estrogen as key player. Microcirculation 2004; 11 (Jan-Feb (1): 9-38)
Johnston, Farrell, Bouchard, Beckerson, Comeau, Lefebvre, Papaioannou. SOGC Joint Com-CPG Gynecology and Urogynecology. Detection and Management of Urogenital Atrophy. J Obstet Gynec Canada 2004; 26 May (5): 503-15)
Suckling, Lethaby, Kennedy. Local Estrogen for vaginal atrophy in Postmenopausal Women. Cochrane Database 2006; 18 October
NAMS. The role of local vaginal estrogen for treatment of vaginal atrophy in postmenopasusal women. 2007 Position Statement) Pitkin, Rees. British Menopause Society Council. Urogenital Atrophy.
Menopause Int 2008; 14 Sept (3) 136-7)
Menopausal women suffering from Atrophic Vaginitis
61%
39%
Women without systemic HRT
With atrophic vaginitis
Without atrophic vaginitis
27%
73%
Women with Systemic HRT
Notelovitz M et al. Obstetrics Gynecology. 2002
Many women using systemic HRT still suffer urogenital symptoms
Menopausal women sufferingfrom atrophic vaginitis
Over half of postmenopausal women will have urogenital discomfort associated with estrogen deficiency
Although many women use oral hormone replacement therapy, urogenital symptoms persist
Patients suffering from atrophic vaginitisPatients not suffering from atrophic vaginitis
73%61%
27%39%
Women with systemic HRT Women without systemic HRT
Notelovitz M, et al. Obstet Gynecol 2002;99:556–62
Physician‘s perspective:
Postmenopausal Vaginal AtrophyIMS recommendations Climacteric 2011SOGC Clinical Practice Guidelines. J Obstet Gynaecol Can 2004
Detection & diagnosis
Health-care providers should routinely assess postmenopausal women for the symptoms and signs of vaginal atrophy, a common condition that exerts significant negative effects on quality of life. (III-C)General
Treatment
1Should be started early and before irrevocable atrophic changes have occurred
2Needs to be continued to maintain the benefits
Postmenopausal Vaginal AtrophyIMS recommendations Climacteric 2011SOGC Clinical Practice Guidelines. J Obstet Gynaecol Can 2004 Estrogen Therapy
1All local estrogen preparations are effective and patient preference will usually determine the treatment used
2All currently available topical estrogens are absorbed, the extent depending on dose and formulation.
3Although systemic absorption of estrogen can occur with local preparations, there is insufficient data to recommend annual endometrial surveillance in asymptomatic women using local estrogens. (III-C)
4Additional progestogen is not indicated when appropriate low-dose, local estrogen is used although long-term data (>1 year) are lacking.
Postmenopausal Vaginal AtrophyIMS recommendations Climacteric 2011SOGC Clinical Practice Guidelines. J Obstet Gynaecol Can 2004
If Estrogen ineffective or undesired
Vaginal lubricants and moisturizers can relieve symptoms due to dryness
Gynecological hormone-responsive cancers
1 Few data on the use of vaginal estrogens sothey should be used with discretion
2 Use of local estrogen in women on tamoxifen or aromatase inhibitors needs careful counselling and discussion with the patient and the oncology team.
However, given the fear many women have of estrogens, there is a motivation to explore alternative therapies.
Vaginal Atrophy & Estrogens
Winneker RC. Progress and Prospects in Treating Postmenopausal Vaginal atrophy. Clinical Pharmacology & Therapeutics Volume 89 Number 1 January 2011
Behavioral Modification Advantage
Are there practical strategies to maintain vaginal moisture?
OPTIONS for maintaining Vaginal Moisture
Diet Tofu, phytoestrogen
Hydration
Key for maintaining moist mucous membranes of the body
Caffeine and alcohol have a diuretic (dehydrating) effect, that can be more pronounced in some women
Women in perimenopause and menopause may have more difficulty clearing the body of these substances, and overconsumption of either — particularly alcohol — can exacerbate vaginal dryness
OPTIONS for maintaining Vaginal Moisture
Medications/Chemicals that may aggravate vaginal dryness
Regulate intake of medications for allergies eg. antihistamine not only dry up sinuses, but vaginal secretions as well.
Chemically-enhanced feminine products / douching: can cause vaginal dryness by disrupting the delicate natural chemical balance of the vagina
OPTIONS for maintaining Vaginal Moisture
Natural Strategies
Kegel exercises help increase circulation to the pelvic area to keep vaginal tissue healthy and strong.
Regular sexual activity should be encouraged to protect against urogenital atrophy, presumably by increasing the blood flow to the pelvic organs. (II-2B)
Leiblum S, et al.Vaginal atrophy in the postmenopausal woman: the importance of sexual activity and hormones. JAMA 1983
SOGC Clinical Practice Guidelines. J Obstet Gynaecol Can 2004
Vaginal Atrophy in the Postmenopausal Woman
The Importance of Sexual Activity and Hormonesn= 52Sexually active: ≥3/moSexually inactive: <10/yr
Index of genital atrophy
Blood samples: estrone estradiol androstenedionetestosterone FSH, LH
Less vaginal atrophy was apparent in the sexually active women as opposed to the sexually inactive women
Women with less vaginal atrophy had significantly higher mean levels of androgens (androstenedione and testosterone) and gonadotropins (particularly LH).
Leiblum S, et al.JAMA 1983
Non-HORMONAL Therapy Modified from NAMS. Menopause Practice: A Clinician's Guide, 3rd edition. Cleveland, OH: The North American Menopause Society; 2007
Composition Therapeutic Relevance
Water-based vaginal lubricants
Use limited to ease penetration during intercourse
Vitamin E oil
Eases penetration during sexual intercourse and may relieve itching, irritation
Non-HORMONAL Therapy Modified from NAMS. Menopause Practice: A Clinician's Guide, 3rd edition. Cleveland, OH: The North American Menopause Society; 2007
Composition Therapeutic Relevance
Vaginal moisturizer
Replenish and maintain water content in the vagina to relieve irritation, itching, and burningNot limited to sexual exchange
Vaginal gel Acidifies vaginal pH, reduces minor vaginal irritations and odors; may be used after intercourse and/or uterine bleeding
Non-HORMONAL Therapy Modified from NAMS. Menopause Practice: A Clinician's Guide, 3rd edition. Cleveland, OH: The North American Menopause Society; 2007
Composition Therapeutic Relevance
Vaginal lubricants
1 Eases penetration during sexual intercourse
2 Water-based, water-soluble, and slightly acidic (pH balanced) preferred. Petroleum products not recommended.
3 This slight acidity inhibits the growth of harmful microorganisms, yeast.
No long term therapeutic effect
Vaginal Moisturizers
Vaginal moisturizers applied on a regular basis
have an efficacy equivalent to local hormone
replacement for the treatment of local urogenital
symptoms such as vaginal itching, irritation, and
dyspareunia, and should be offered to women
wishing to avoid use of hormone replacement
therapy. (I-A)
SOGC Clinical Practice Guidelines. J Obstet Gynaecol Can 2004
POLYCARBOPHIL – BISABOLOLLACTIC ACID VAGINAL MOISTURIZING GEL
Polycarbophil-Bisabolol Lactic Acid Vaginal gel
Poly carbophil
1 Bioadhesive polymer in gel form Draws water out of the cells into the vagina Prevents volatilization of amines Promotes restoration of lactobacilli and acidifies vaginal pH
2 A weak polyacid ph=2.8Its large molecule is neither absorbed nor immunogenic.
3 With its multiple carboxyl radicals, it adheres to the vaginal epithelial cells until they turn over (3-5 days) and buffers vaginal secretionsCells regain natural elasticity and moisturePromotes healing of tissues.
Polycarbophil-Bisabolol Lactic Acid Vaginal gel
α-Bisabolol
1 A Levomenol, a natural monocyclic sesquiterpene ROH
2 Colorless viscous oil, the primary constituent of the essential oil from German chamomile
3 Almost insoluble in water and glycerin, well soluble in ethanol
4 Has skin healing properties.Known to have anti-irritant, anti-inflammatory and anti-microbial properties.
Polycarbophil-Bisabolol Lactic Acid Vaginal gel
LACTIC Acid
Acidifies vaginal pHReduces minor vaginal irritations and odorsMay be used after intercourse and/or uterine bleeding
STUDIES on EFFICACY and SAFETY
Polycarbophil vs. local Estrogen in menopausal women (Nachtigall LE. Fertil Steril Jan 1994)
Study n= 30>1year postmenopause, not on HRT, cancer-free and experiencing vaginal discomfort or dyspareunia.
Randomized Polycarbophil gel 3x/week for 12weeks
CEE cream 2g vaginally daily for 12weeks
Parameters Pap smear, vaginal pH, MI index (baseline, week4, week8, week12)
Polycarbophil vs. local Estrogen in menopausal women (Nachtigall LE. Fertil Steril Jan 1994)
Results 1 Both had statistically significant return of vaginal moisture and vaginal fluid and premenopause pH levels by week 4
2 Women remained free of vaginal infections for the duration of the study
3 Both have increased vaginal elasticity; Statistically significant in the estrogen group by week4
4 Vaginal atrophy reversed at week12 in estrogen group.
Polycarbophil vs. local Estrogen in menopausal women (Nachtigall LE. Fertil Steril Jan 1994)
Conclusion Polycarbophil gel is safe and an effective alternative to estrogen vaginal cream in postmenopausal women with uncomfortable symptoms of vaginal dryness, exhibiting increases in vaginal elasticity with return to premenopausal pH state
Polycarbophil versus dienoestrol cream in the symptomatic treatment of vaginal atrophy in postmenopausal women.(Bygdeman M, Swahn ML. Maturitas 1996)
Study n= 39Polycarbophil gel 3x/week for 12weeksDienoestrol daily during the first 2 weeks and thereafter 3x a week
Randomized
Parameters Vaginal dryness index, itching, irritation, dyspareunia, pH and safety were evaluated every week the first month and every month thereafter.
Polycarbophil vs. local Estrogen in menopausal women (Nachtigall LE. Fertil Steril Jan 1994)
Results 1 Both treatments had a significant increase on vaginal dryness index as soon as the first week of treatment. Hormonal compound was significantly better than the non-hormonal one
2 All symptoms such as itching, irritation and dyspareunia significantly decreased or disappeared without any difference between the two treatments
Polycarbophil vs. local Estrogen in menopausal women (Nachtigall LE. Fertil Steril Jan 1994)
Conclusion
Polycarbophil applied vaginally 3x a week, is a full therapy for all symptoms of vaginal atrophy as well as local estrogen. No serious adverse event was related.It is an alternative treatment to local estrogen and perhaps a good complement of systemic HRT in patient suffering from vaginal dryness.
Effect on Vaginal pH of a polycarbophil vaginal gel compared with acidic douche in women with suspected BV (Massimo M, Bruno M, Ilaria S. Current Therapeutic Research, Oct 2000)
Objective To compare and assess the pH-lowering effect of polycarbophil with acidic vaginal douche
Controlled, Randomized Blinded study
n=30 (18-60 yo), vaginal pH>4.5 & suspected BV (+ whiff test; + clue cells, gram stain score ≥4)
Groups 6 weeks:Polycarbophil gel 2.5gAcidic vaginal douche 2x a week
Effect on Vaginal pH of a polycarbophil vaginal gel compared with acidic douche in women with suspected BV (Massimo M, Bruno M, Ilaria S. Current Therapeutic Research, Oct 2000)
Outcomes Measured by investigator
Baseline, 3 wks, 6 wks
Vaginal pH, wet mount, KOH, Gram stain
Specimen obtained 8hrs after gel / douche use; day7 from LMP; 48hrs post-coital
Effect on Vaginal pH of a polycarbophil vaginal gel compared with acidic douche in women with suspected BV (Massimo M, Bruno M, Ilaria S. Current Therapeutic Research, Oct 2000)
polycarbophil
acidic douche
Effect on Vaginal pH of a polycarbophil vaginal gel compared with acidic douche in women with suspected BV (Massimo M, Bruno M, Ilaria S. Current Therapeutic Research, Oct 2000)
Results
Vaginal pH
Polycarbophil Acidic Douche
Week 3 4.7 (+/- 0.6) 5.4 +/- 0.5
Week 6 4.6 (+/- 0.7) pH 5.3 +/- 0.8
pH lowering effect of polycarbophil after single application is maintained up to 80 hrs
Effect on BV
Physical & microbiological signs of BV improved in the polycarbophil group
Adverse effects
No adverse effects noted in both groups
Effect on Vaginal pH of a polycarbophil vaginal gel compared with acidic douche in women with suspected BV (Massimo M, Bruno M, Ilaria S. Current Therapeutic Research, Oct 2000)
Conclusions
Polycarbophil vaginal gel reduces vaginal pH to almost physiologic levels and reduces vaginal pH in women suspected of BV, compared with acidic vaginal douche.
Polycarbophil may thus represent not only a way to reduce vaginal acidity and help maintain physiologic levels but may play an important role in preventing complications related to altered vaginal pH.
GYNECOLOGIC MANAGEMENT OF SEXUAL PAIN FROM ATROPHIC VAGINITIS AND VAGINAL ATROPHYCurr Oncology 2007 December; C. Derzko, MD,* S. Elliott, MD,† and W. Lam, BSc(Pharm) MD‡
In view of recent findings raising concerns over elevated circulating estradiol levels (from 0-5pmol/l to 72pmol/l) in breast cancer patients on AI therapy who are using transvaginal estrogenic preparations,
GYNECOLOGIC MANAGEMENT OF SEXUAL PAIN FROM ATROPHIC VAGINITIS AND VAGINAL ATROPHYCurr Oncology 2007 December; C. Derzko, MD,* S. Elliott, MD,† and W. Lam, BSc(Pharm) MD‡
In view of recent findings raising concerns over elevated circulating estradiol levels in breast cancer patients on AI therapy who are using transvaginal estrogenic preparations, non-hormonal therapies including regular application of vaginal moisturizers and lubricants are recommended and certainly be first-line therapy. In addition, pelvic therapy for pelvic tone awareness and pelvic floor exercises (eg, Kegel exercises) and lifestyle modification are preferred and should be considered early.
Practical Clinical Guidelines for Assessing and Managing Sexual Dysfunction and Atrophic Vaginitis after Breast CAM. Hickey; C. Saunders; A. Partridge; N. Santoro; H. Joffe; V. Stearns. Annals of Oncology Oct 2008 19(10):1669-1680
Vaginal estradiol may reverse efficacy of aromatase inhibitors in suppressing estrogen.
Estriol-containing preparations may be helpful, however, safety is still not established.
When vaginal dryness is contributory, non-hormonal agents such as vaginal moisturizers (polycarbophil-containing) may be effective for hypoactive sexual desire in these women.
Testosterone therapy is offered by some clinicians but it’s safety and efficacy have not been well-established.
MANAGING UROGENITAL ATROPHY: A Review Palacios S. Maturitas 63 (2009) 315-18
MANAGING UROGENITAL ATROPHYPalacios S. Maturitas 63 (2009) 315-18
The review provides a practical guide on the diagnosis and management of UGA.
A literature search done in MEDLINE (1969-2008) for original reports, meta-analysis and guidelines.
15% of premenopausal women and 40-57% of postmenopausal women have symptoms related to UGA. However, <25% receive medical care.
MANAGING UROGENITAL ATROPHYPalacios S. Maturitas 63 (2009) 315-18
cont’d . . . . .
Lubricants are temporary measures to relieve vaginal dryness during intercourse, and moisturizers give longer symptomatic relief and has an effect on the vaginal epithelium maturity.
Estrogen given systemically in all dosage regimens is effective, but topical therapy alone is preferred if systemic treatment is not needed.
Treatment may be for long term as symptoms return when treatment is stopped.
MANAGING UROGENITAL ATROPHYPalacios S. Maturitas 63 (2009) 315-18
ESTROGEN THERAPY 2006 Cochrane systematic review of 19 good quality
trials (4162 postmenopausal women randomized to different estrogen preparations for 3-6 months, and endpoints were efficacy, safety, acceptability; vaginal estradiol tablets more effective than the ring and clearly superior over placebo for symptom-relief).
Meta-analysis by Cardozo et al showed superiority of estrogen over placebo, and that the vaginal route is linked to a better outcome in UGA.
Conjugated estrogen cream, an intravaginal sustained-release estradiol ring, or estradiol vaginal tablets are recommended as effective treatment for vaginal atrophy. (IA)
Routine progestin cotherapy is not required for endometrial protection in women receiving vaginal estrogen therapy in appropriate dose. (IIIC)
Vaginal lubricants, moisturizers may be recommended for subjective symptom improvement of dyspareunia. (IIIC)
Health care providers can offer polycarbophil gel (a vaginal moisturizer) as an effective treatment for symptoms of vaginal atrophy, including dryness and dyspareunia. (IA)
Johnston S. Urogenital concerns. In: Canadian consensus conference on menopause. J Obstet Gynaecol Can
Urogenital Health Update 2009
SUMMARY
Threats to normal vaginal health at any stage of a woman’s life
Vaginal dryness associated with altered vaginal health is a concern but only a few seek medical care
SUMMARY
Polycarbophil-containing vaginal moisturizers reduce vaginal ph and improves moisture content and is effective for relief of vaginal dryness.
Initial studies of polycarbophil on maintaining acid vaginal ph and low IL-6 in low risk pregnant women seem promising and may be linked in the reduction of adverse pregnancy outcome.
Polycarbophil vaginal gel can be offered for managing vaginal dryness in breast CA patients.
VAGINAL DRYNESS, an emerging concern . . . . .
POLYCARBOPHIL-α BISABOLOL – LACTIC Acid containing vaginal gel, with its vaginal moisture elasticity, and pH- restoring properties, is a rational option.
VAGINAL MOISTURIZERS:
A REAL NEED