REVIEW   

Minerva Ginecologica 2017 August;69(4):370-80

DOI: 10.23736/S0026-4784.17.04064-3

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Clinical profile of women with vulvar and vaginal atrophy who are not candidates for local vaginal estrogen therapy

Rossella E., NAPPI ¹ ✉, Filippo MURINA ², Giuseppina PERRONE ³, Paola VILLA ⁴, Nicoletta BIGLIA ⁵

¹ Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, University of Pavia, Pavia, Italy; ² Unit of Lower Genital Tract Disease, V. Buzzi University Hospital, Milan, Italy; ³ Department of Gynecology, Obstetrics and Urological Sciences, “Sapienza” University of Rome, Umberto I Policlinic, Rome, Italy;4 Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Rome, Italy; ⁵ Department of Obstetrics and Gynecology, School of Medicine, University of Turin, Turin, Italy

Vulvar and vaginal atrophy (VVA) is a chronic medical condition in postmenopausal women, which is predominantly due to a permanent cessation of ovarian estrogen production. Current available treatment options for VVA are over-the-counter (OTC) symptomatic relief products or local estrogen therapy (LET) aiming to treat this underlying atrophic condition. Recent surveys indicated that these products decrease sexual spontaneity, are messy and indiscrete. Ospemifene is an oral daily drug, which has proven to treat vaginal dryness and dyspareunia effectively. However, despite the comparable efficacy of ospemifene versus placebo to estrogen versus placebo, ospemifene is currently indicated for women, who are not candidates for LET. It is up to the gynecologist to make an appropriate therapeutic decision. There are potential candidates who have not been considered for ospemifene and yet would benefit from this treatment, such as breast cancer survivors, or patients unable to perform or that have problems performing vaginal insertion/application of estrogen based treatments, such as women that suffer from prolapse. Likewise, a patient’s concern for hormone treatment safety, treatment regimens complexity or cross contamination with their partner are potential issues to consider when prescribing treatment for VVA in order to provide the best therapeutic option for patients who are generally not compliant with their current therapy.

KEY WORDS: Postmenopause - Dyspareunia - Ospemifene - Selective estrogen receptor modulators