Management of vulvovaginal atrophy-related sexual dysfunction in postmenopausal women: An up-to-date review

Menopause

Volumn 19, Issue 1, 2012, Pages 109-117

  Tan, Orkun ^a   Bradshaw, Karen ^a   Carr, Bruce R ^a  

^a UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER   (United States)

Author keywords

Dehydroepiandrosterone; Estrogens; Menopause; Selective estrogen receptor modulators; Sexual dysfunction; Vulvovaginal atrophy

Indexed keywords

ANASTROZOLE; AROMATASE INHIBITOR; ASTROGLIDE; BAZEDOXIFENE; CONJUGATED ESTROGEN; EMERITA; ESTRADIOL; ESTRADIOL ACETATE; ESTRIOL; ESTROGEN; K Y JELLY; K Y LIQUIBEADS; LASOFOXIFENE; LUBRICATING AGENT; OSPEMIFENE; PECTIN; POLYCARBOPHIL; PRASTERONE; REPHRESH; SELECTIVE ESTROGEN RECEPTOR MODULATOR; SLIPPERY STUFF; SUMMERS EVE; TAMOXIFEN; TESTOSTERONE; UNCLASSIFIED DRUG;

BREAST CANCER; CANCER PATIENT; CREAM; DRUG DOSE COMPARISON; DRUG EFFICACY; DRUG FORMULATION; DRUG SAFETY; DYSPAREUNIA; ESTROGEN BLOOD LEVEL; ESTROGEN THERAPY; FEMALE; FEMALE SEXUAL DYSFUNCTION; HORMONAL THERAPY; HUMAN; LIBIDO DISORDER; LOW DRUG DOSE; PATIENT COMPLIANCE; PATIENT SATISFACTION; PHASE 2 CLINICAL TRIAL (TOPIC); PHASE 3 CLINICAL TRIAL (TOPIC); POSTMENOPAUSE; POSTMENOPAUSE OSTEOPOROSIS; REVIEW; SEXUAL DYSFUNCTION; SUSTAINED DRUG RELEASE; TABLET; TRANSVAGINAL ECHOGRAPHY; TREATMENT OUTCOME; VAGINA ATROPHY; VAGINA RING;

ADMINISTRATION, INTRAVAGINAL; ADULT; AGED; AGED, 80 AND OVER; ATROPHY; BREAST NEOPLASMS; COMPLEMENTARY THERAPIES; DEHYDROEPIANDROSTERONE; ESTROGENS; FEMALE; HUMANS; LUBRICANTS; MIDDLE AGED; POSTMENOPAUSE; SELECTIVE ESTROGEN RECEPTOR MODULATORS; SEXUAL DYSFUNCTION, PHYSIOLOGICAL; VAGINA; VULVA;

EID: 84655162729     PISSN: 10723714     EISSN: 15300374     Source Type: Journal    
DOI: 10.1097/gme.0b013e31821f92df     Document Type: Review

References (95)

1. Dennerstein L, Randolph J, Taffe J, Dudley E, Burger H. Hormones, mood, sexuality, and the menopausal transition. Fertil Steril 2002;77: S42-S48. (Pubitemid 34465843)
2. Diokno AC, Brown MB, Herzog AR. Sexual function in the elderly. Arch Intern Med 1990;150:197-200. (Pubitemid 20085220)
3. Nusbaum MR, Gamble G, Skinner B, Heiman J. The high prevalence of sexual concerns among women seeking routine gynecological care. J Fam Pract 2000;49:229-232. (Pubitemid 30461290)
4. Floter A, Nathorst-Boos J, Carlstrom K, von Schoultz B. Addition of testosterone to estrogen replacement therapy in oophorectomized women: effects on sexuality and well-being. Climacteric 2002;5:357-365. (Pubitemid 36149723)
5. Meston CM. Aging and sexuality. West J Med 1997;167:285-290. (Pubitemid 27451238)
6. Nappi RE, Lachowsky M. Menopause and sexuality: prevalence of symptoms and impact on quality of life. Maturitas 2009;63:138-141.
7. O'Connell HE, Hutson JM, Anderson CR, Plenter RJ. Anatomical relationship between urethra and clitoris. J Urol 1998;159:1892-1897. (Pubitemid 29190719)
8. Longcope C. Metabolic clearance and blood production rates of estrogens in postmenopausal women. Am J Obstet Gynecol 1971;111: 778-781.
9. Lobo RA. Menopause and aging. In: Strauss JF III, Barbieri RL, eds. Yen and Jaffe's Reproductive Endocrinology. 5th ed. Philadelphia, PA: Elsevier Saunders, 2004:421-452.
10. Hodgins MB, Spike RC, Mackie RM, MacLean AB. An immune his to chemical study of androgen, oestrogen and progesterone receptors in the vulva and vagina. Br J Obstet Gynaecol 1998;105:216-222. (Pubitemid 28096304)
11. Onnis A, Nardelli GB, Lamaina V, Mozzanega B, Becagli L, Fais GF. Hormonal receptors in vulvar tissues. Eur J Gynaecol Oncol 1985;6: 125-128. (Pubitemid 15067662)
12. Pettersson K, Gustafsson JA. Role of estrogen receptor A in estrogen action. Annu Rev Physiol 2001;63:165-192.
13. Castelo-Branco C, Cancelo MJ, Villero J, Nohales F, Julia MD. Management of post-menopausal vaginal atrophy and atrophic vaginitis. Maturitas 2005;52:S46-S52. (Pubitemid 41630619)
14. Smith P. Estrogens and the urogenital tract. Studies on steroid hormone receptors and a clinical study on a new estradiol-releasing vaginal ring. Acta Obstet Gynecol Scand Suppl 1993;157:1-26.
15. Caillouette JC, Sharp CF Jr, Zimmerman GJ, Roy S. Vaginal pH as a marker for bacterial pathogens and menopausal status. Am J Obstet Gynecol 1997;176:1270-1275; discussion 5-7.
16. Paavonen J. Physiology and ecology of the vagina. Scand J Infect Dis Suppl 1983;40:31-35. (Pubitemid 14201775)
17. Raffi RO, Moghissi KS, Sacco AG. Proteins of human vaginal fluid. Fertil Steril 1977;28:1345-1348. (Pubitemid 8257804)
18. Semmens JP, Tsai CC, Semmens EC, Loadholt CB. Effects of estrogen therapy on vaginal physiology during menopause. Obstet Gynecol 1985; 66:15-18. (Pubitemid 15047375)
19. Robinson D, Cardozo LD. The role of estrogens in female lower urinary tract dysfunction. Urology 2003;62:45-51. (Pubitemid 41116582)
20. Calleja-Agius J, Brincat MP. Urogenital atrophy. Climacteric 2009;12: 279-285.
21. Panay N. Menopause and the postmenopausal woman. In: Edmonds DK, ed. Dewhurst's Textbook of Obstetrics and Gynaecology. Oxford, UK: Blackwell Publishing, 2008:479-495.
22. Bachmann GA, Leiblum SR, Kemmann E, Colburn DW, Swartzman L, Shelden R. Sexual expression and its determinants in the post-menopausal woman. Maturitas 1984;6:19-29. (Pubitemid 14088225)
23. Oriba HA, Maibach HI. Vulvar transepidermal water loss (TEWL) decay curves. Effect of occlusion, delipidation, and age. Acta Derm Venereol 1989;69:461-465. (Pubitemid 20000545)
24. Bachmann GCR, Rovner E. Treatment of the Postmenopausal Woman. New York, NY: Elsevier, 2007:263-269.
25. Carranza-Lira S, Fragoso-Diaz N, MacGregor-Gooch AL, Garduno- Hernandez MP, Rios-Calderon K, Aparicio H. Vaginal dryness assessment in postmenopausal women using pH test strip. Maturitas 2003;45: 55-58. (Pubitemid 36712892)
26. Simon J, Nachtigall L, Gut R, Lang E, Archer DF, Utian W. Effective treatment of vaginal atrophy with an ultra-low-dose estradiol vaginal tablet. Obstet Gynecol 2008;112:1053-1060.
27. Cayan F, Dilek U, Pata O, Dilek S. Comparison of the effects of hormone therapy regimens, oral and vaginal estradiol, estradiol + drospirenone and tibolone, on sexual function in healthy postmenopausal women. J Sex Med 2008;5:132-138.
28. Al-Baghdadi O, Ewies AA. Topical estrogen therapy in the management of postmenopausal vaginal atrophy: an up-to-date overview. Climacteric 2009;12:91-105.
29. Estrace vaginal cream labeling. September 2009. Rockaway, NJ: Warner Chilcott (US), LLC. Available at: http://www.wcrx.com/pdfs/pi/pi-ppi-estrace- cream.pdf. Accessed January 6, 2011.
30. Femring labeling. Rockaway, NJ: Warner Chilcott (US), LLC. September 2009. Accessed January 16, 2011.
31. Estring labeling. August 2008. New York, NY: Pharmacia & UpJohn, Division of Pfizer Inc. Available at: http://media.pfizer.com/files/products/ uspi-estring.pdf. Accessed February 5, 2011.
32. Vagifem labeling. November 5, 2009. Princeton, NJ: Novo Nordisk Inc. Available at: http://www.vagifemhcp.com/contents/files/vagifempi.pdf. Accessed February 14, 2011.
33. Premarin (conjugated estrogen) vaginal cream labeling. April 2010. Philadelphia, PA: Wyeth Pharmaceuticals Inc, Division of Pfizer. Available at: http://www.wyeth.com/content/showlabelingasp?id=132. Accessed February 3, 2011.
34. The North American Menopause Society. Estrogen and progestogen use in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause 2010;17:242-255.
35. Crandall C. Vaginal estrogen preparations: a review of safety and efficacy for vaginal atrophy. J Womens Health (Larchmt) 2002;11:857-877. (Pubitemid 36322425)
36. Bachmann G, Bouchard C, Hoppe D, et al. Efficacy and safety of lowdose regimens of conjugated estrogens cream administered vaginally. Menopause 2009;16:719-727.
37. Speroff L. Efficacy and tolerability of a novel estradiol vaginal ring for relief of menopausal symptoms. Obstet Gynecol 2003;102:823-834. (Pubitemid 37206420)
38. Nachtigall LE. Clinical trial of the estradiol vaginal ring in the U.S. Maturitas 1995;22:S43-S47. (Pubitemid 26022540)
39. Lose G, Englev E. Oestradiol-releasing vaginal ring versus oestriol vaginal pessaries in the treatment of bothersome lower urinary tract symptoms. BJOG 2000;107:1029-1034. (Pubitemid 30495461)
40. Ayton RA, Darling GM, Murkies AL, et al. A comparative study of safety and efficacy of continuous low dose oestradiol released from a vaginal ring compared with conjugated equine oestrogen vaginal cream in the treatment of postmenopausal urogenital atrophy. Br J Obstet Gynaecol 1996;103:351-358. (Pubitemid 26106031)
41. Goldstein I, Alexander JL. Practical aspects in the management of vaginal atrophy and sexual dysfunction in perimenopausal and postmenopausal women. J Sex Med 2005;2:154-165. (Pubitemid 41727408)
42. 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;14:355-369; quiz 70-71.
43. Suckling J, Lethaby A, Kennedy R. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev 2006;4: CD001500.
44. Ibe C, Simon JA. Vulvovaginal atrophy: current and future therapies (CME). J Sex Med 2010;7:1042-1050; quiz 51.
45. Bachmann G, Gass M, Kagan R, Moffett A, Barcomb L, Symons J. Lasofoxifene (laso), a next generation selective estrogen response modulator (SERM) improves dyspareunia in postmenopausal women with vaginal atrophy (VA) [abstract erratum]. Menopause 2005;12:238.
46. Bachmann G, Gass M, Moffett A, Portman D, Symons J. Lasofoxifene improves symptoms associated with vaginal atrophy [abstract]. Menopause 2004;11:P63.
47. Goldstein SR, Cummings SR, Eastell R, Ensrud K, et al. Vaginal effects of lasofoxifene: 3-year results from the PEARL Trial. Menopause 2008; 15:1228.
48. Portman D, Moffett A, Kerber I, Drosman S, Somayaji V, Lee A. Lasofoxifene, a selective estrogen receptor modulator, improves objective measures of vaginal atrophy. Menopause 2004;11:675.
49. Simon JA, Komi J. Ospemifene, a new SERM, improves the symptoms of vaginal dryness and dyspareunia in postmenopausal women: results from a pivotal Phase 3 study. Paper presented at: 12th World Congress on the Menopause International Menopause Society; May 19-23, 2008; Madrid, Spain.
50. Baker VL, Leitman D, Jaffe RB. Selective estrogen receptor modulators in reproductive medicine and biology. Obstet Gynecol Surv 2000;55: S21-S47.
51. Shelly W, Draper MW, Krishnan V, Wong M, Jaffe RB. Selective estrogen receptor modulators: an update on recent clinical findings. Obstet Gynecol Surv 2008;63:163-181. (Pubitemid 351612435)
52. Lobo RA, Rosen RC, Yang HM, Block B, Van Der Hoop RG. Comparative effects of oral esterified estrogens with and without methyltestosterone on endocrine profiles and dimensions of sexual function in postmenopausal women with hypoactive sexual desire. Fertil Steril 2003;79:1341-1352. (Pubitemid 36687880)
53. Bachmann GA, Komi JO. Ospemifene effectively treats vulvovaginal atrophy in postmenopausal women: results from a pivotal phase 3 study. Menopause 2010;17:480-486.
54. Archer DF. Tissue-selective estrogen complexes: a promising option for the comprehensive management of menopausal symptoms. Drugs Aging 2010;27:533-544.
55. Winneker RC, Harris HA. Progress and prospects in treating postmenopausal vaginal atrophy. Clin Pharmacol Ther 2011;89:129-132.
56. Miller PD, Chines AA, Christiansen C, et al. Effects of bazedoxifene on BMD and bone turnover in postmenopausal women: 2-yr results of a randomized, double-blind, placebo-, and active-controlled study. J Bone Miner Res 2008;23:525-535. (Pubitemid 351501893)
57. Silverman SL, Christiansen C, Genant HK, et al. Efficacy of bazedoxifene in reducing new vertebral fracture risk in postmenopausal women with osteoporosis: results from a 3-year, randomized, placebo-, and active-controlled clinical trial. J Bone Miner Res 2008;23:1923-1934.
58. Lobo RA, Pinkerton JV, Gass ML, et al. Evaluation of bazedoxifene/ conjugated estrogens for the treatment of menopausal symptoms and effects on metabolic parameters and overall safety profile. Fertil Steril 2009;92:1025-1038.
59. Panjari M, Davis SR. DHEA for postmenopausal women: a review of the evidence. Maturitas 2010;66:172-179.
60. Al-Azzawi F, Bitzer J, Brandenburg U, et al. Therapeutic options for postmenopausal female sexual dysfunction. Climacteric 2010;13: 103-120.
61. Baulieu EE, Thomas G, Legrain S, et al. Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: contribution of the DHEAge Study to a sociobiomedical issue. Proc Natl Acad Sci U S A 2000;97: 4279-4284. (Pubitemid 30226124)
62. Hackbert L, Heiman JR. Acute dehydroepiandrosterone (DHEA) effects on sexual arousal in postmenopausal women. J Womens Health Gend Based Med 2002;11:155-162.
63. Kritz-Silverstein D, von Muhlen D, Laughlin GA, Bettencourt R. Effects of dehydroepiandrosterone supplementation on cognitive function and quality of life: the DHEA and Well-Ness (DAWN) Trial. J Am Geriatr Soc 2008;56:1292-1298.
64. Morales AJ, Nolan JJ, Nelson JC, Yen SS. Effects of replacement dose of dehydroepiandrosterone in men and women of advancing age. J Clin Endocrinol Metab 1994;78:1360-1367. (Pubitemid 24181005)
65. Mortola JF, Yen SS. The effects of oral dehydroepiandrosterone on endocrine-metabolic parameters in postmenopausal women. J Clin Endocrinol Metab 1990;71:696-704.
66. Wolf OT, Neumann O, Hellhammer DH, et al. Effects of a two-week physiological dehydroepiandrosterone substitution on cognitive performance and well-being in healthy elderly women and men. J Clin Endocrinol Metab 1997;82:2363-2367. (Pubitemid 27287613)
67. Panjari M, Bell RJ, Jane F, et al. A randomized trial of oral DHEA treatment for sexual function, well-being, and menopausal symptoms in postmenopausal women with low libido. J Sex Med 2009; 6:2579-2590.
68. Arlt W, Callies F, van Vlijmen JC, et al. Dehydroepiandrosterone replacement in women with adrenal insufficiency. N Engl J Med 1999; 341:1013-1020. (Pubitemid 29451796)
69. Labrie F, Cusan L, Gomez JL, et al. Effect of intravaginal DHEA on serum DHEA and eleven of its metabolites in postmenopausal women. J Steroid Biochem Mol Biol 2008;111:178-194.
70. Labrie F, Archer D, Bouchard C, et al. High internal consistency and efficacy of intravaginal DHEA for vaginal atrophy. Gynecol Endocrinol 2010;26:524-532.
71. Labrie F, Archer D, Bouchard C, et al. Effect of intravaginal dehydroepiandrosterone (Prasterone) on libido and sexual dysfunction in postmenopausal women. Menopause 2009;16:923-931.
72. Stika CS. Atrophic vaginitis. Dermatol Ther 2010;23:514-522.
73. Bygdeman M, Swahn ML. Replens versus dienoestrol cream in the symptomatic treatment of vaginal atrophy in postmenopausal women. Maturitas 1996;23:259-263. (Pubitemid 26000605)
74. Gennari L. Lasofoxifene, a new selective estrogen receptor modulator for the treatment of osteoporosis and vaginal atrophy. Expert Opinion Pharmacotherapy 2009;10:2209-2220.
75. Johnston SL, Farrell SA, Bouchard C, et al. The detection and management of vaginal atrophy. J Obstet Gynaecol Can 2004;26:503-515.
76. Kwan KW, Chlebowski RT. Sexual dysfunction and aromatase inhibitor use in survivors of breast cancer. Clin Breast Cancer 2009;9: 219-224.
77. Ewertz M, Jensen AB. Late effects of breast cancer treatment and potentials for rehabilitation. Acta Oncol 2011;50:187-193.
78. Hickey M, Peate M, Saunders CM, Friedlander M. Breast cancer in young women and its impact on reproductive function. Hum Reprod Update 2009;15:323-339.
79. Wilmoth MC, Botchway P. Psychosexual implications of breast and gynecologic cancer. Cancer Invest 1999;17:631-636.
80. Ganz PA, Greendale GA, Petersen L, Zibecchi L, Kahn B, Belin TR. Managing menopausal symptoms in breast cancer survivors: results of a randomized controlled trial. J Natl Cancer Inst 2000;92: 1054-1064. (Pubitemid 30618024)
81. Haspels AA, Luisi M, Kicovic PM. Endocrinological and clinical investigations in post-menopausal women following administration of vaginal cream containing oestriol. Maturitas 1981;3:321-327. (Pubitemid 12145703)
82. Morales L, Neven P, Timmerman D, et al. Acute effects of tamoxifen and third-generation aromatase inhibitors on menopausal symptoms of breast cancer patients. Anticancer Drugs 2004;15:753-760. (Pubitemid 39281298)
83. Cella D, Fallowfield L, Barker P, Cuzick J, Locker G, Howell A. Quality of life of postmenopausal women in the ATAC ('Arimidex,' tamoxifen, alone or in combination) trial after completion of 5 years' adjuvant treatment for early breast cancer. Breast Cancer Res Treat 2006;100:273-284. (Pubitemid 44707921)
84. Cuzick J, Sestak I, Baum M, et al. Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 10-year analysis of the ATAC trial. Lancet Oncol 2010;11:1135-1141.
85. Witherby S, Johnson J, Demers L, et al. Topical testosterone for breast cancer patients with vaginal atrophy related to aromatase inhibitors: a phase I/II study. Oncologist 2011;16:424-431.
86. Dew JE, Wren BG, Eden JA. A cohort study of topical vaginal estrogen therapy in women previously treated for breast cancer. Climacteric 2003;6:45-52. (Pubitemid 36398872)
87. Ponzone R, Biglia N, Jacomuzzi ME, Maggiorotto F, Mariani L, Sismondi P. Vaginal oestrogen therapy after breast cancer: is it safe? Eur J Cancer 2005;41:2673-2681. (Pubitemid 41607558)
88. Biglia N, Cozzarella M, Cacciari F, et al. Menopause after breast cancer: a survey on breast cancer survivors. Maturitas 2003;45:29-38. (Pubitemid 36712889)
89. Biglia N, Peano E, Sgandurra P, et al. Low-dose vaginal estrogens or vaginal moisturizer in breast cancer survivors with urogenital atrophy: a preliminary study. Gynecol Endocrinol 2010;26:404-412.
90. Kaufert P, Boggs PP, Ettinger B, Woods NF, Utian WH. Women and menopause: beliefs, attitudes, and behaviors. The North American Menopause Society 1997 Menopause Survey. Menopause 1998;5: 197-202. (Pubitemid 28562721)
91. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin no. 28: Clinical Management Guidelines for Obstetrician- Gynecologists. Use of botanicals for management of menopausal symptoms. Obstet Gynecol 2001;97(suppl):1-11.
92. Yildirim B, Kaleli B, Duzcan E, Topuz O. The effects of postmenopausal Vitamin D treatment on vaginal atrophy. Maturitas 2004;49:334-337. (Pubitemid 39505188)
93. Reed SD, Newton KM, LaCroix AZ, Grothaus LC, Grieco VS, Ehrlich K. Vaginal, endometrial, and reproductive hormone findings: randomized, placebo-controlled trial of black cohosh, multibotanical herbs, and dietary soy for vasomotor symptoms: the Herbal Alternatives for Menopause (HALT) Study. Menopause 2008;15:51-58.
94. Nauth HF, Boger A. New aspects of vulvar cytology. Acta Cytol 1982;26:1-6. (Pubitemid 12169592)
95. Pinkerton JV, Stovall DW. Bazedoxifene when paired with conjugated estrogens is a new paradigm for treatment of postmenopausal women. Expert Opin Investig Drugs 2010;19:1613-1621.