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Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society
Gloria A. Bachman,Steven R. Goldstein,James H. Liu,Mark G. Martens,Diane Todd Pace,JoAnn V. Pinkerton +5 more
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TLDR
Clinicians can improve the sexual health and QOL of postmenopausal women by educating women about, diagnosing, and appropriately managing symptomatic VVA.Abstract:
Objective: To update and expand the previous position statement of The North American Menopause Society (NAMS) on the management of symptomatic vulvovaginal atrophy (VVA) in postmenopausal women. Methods: NAMS searched PubMed for medical literature on VVA published since their 2007 position statement on the role of local vaginal estrogen for treatment of vaginal atrophy in postmenopausal women. A panel of acknowledged experts in the field of genitourinary health reviewed the literature to evaluate new evidence on local estrogen as well as on other management options available or in development for symptomatic VVA. The panel_s conclusions and recommendations were reviewed and approved by the NAMS Board of Trustees. Results: Symptomatic VVA can significantly impair the quality of life (QOL) of postmenopausal women and may be underdiagnosed. In most cases, it can be managed successfully. A number of over-the-counter and government-approved prescription therapies available in the United States and Canada demonstrate effectiveness, depending on the severity of VVA symptoms. These include vaginal lubricants and moisturizers, vaginal estrogen, hormone therapy, and the selective estrogen-receptor modulator ospemifene (indicated for dyspareunia). Longterm studies on the endometrial safety of local estrogen and ospemifene are lacking. Changes in the vaginal microbiome have various effects on symptoms. Conclusions: Clinicians can improve the sexual health and QOL of postmenopausal women by educating women about, diagnosing, and appropriately managing symptomatic VVA. Choice of therapy depends on the severity of symptoms, the effectiveness and safety of therapy for the individual patient, and patient preference. Estrogen therapy is the most effective treatment for moderate to severe symptoms, although a direct comparison of estrogen and ospemifene is not available. Nonhormonal therapies available without a prescription provide sufficient relief for most women with mild symptoms. When low-dose estrogen is administered locally, a progestogen is not indicated for women without a uterus and generally is not indicated for women with an intact uterus. However, endometrial safety has not been studied in clinical trials beyond 1 year. There are insufficient data to confirm the safety of local estrogen in women with breast cancer; management of VVA should take the woman’s needs and the recommendation of her oncologist into consideration. Research on the vaginal microbiome may lead to other therapies in the future.read more
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Treatment of symptoms of the menopause: an Endocrine Society Clinical Practice Guideline
Cynthia A. Stuenkel,Cynthia A. Stuenkel,Susan R. Davis,Anne Gompel,Mary Ann Lumsden,Mary Ann Lumsden,M. Hassan Murad,JoAnn V. Pinkerton,JoAnn V. Pinkerton,Richard J. Santen,Richard J. Santen +10 more
TL;DR: Menopausal hormone therapy (MHT) is the most effective treatment for vasomotor symptoms and other symptoms of the climacteric and benefits may exceed risks for the majority of symptomatic postmenopausal women who are under age 60 or under 10 years since the onset of menopause.
Journal ArticleDOI
Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society.
David Portman,Margery Gass +1 more
TL;DR: The term genitourinary syndrome of menopause (GSM) is a medically more accurate, all-encompassing, and publicly acceptable term than vulvovaginal atrophy and was formally endorsed by the respective Boards of NAMS and ISSWSH in 2014.
Journal ArticleDOI
Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women ' s Sexual Health and The North American Menopause Society
David Portman,Margery Gass +1 more
TL;DR: GSM is defined as a collection of symptoms and signs associated with a decrease in estrogen and other sex steroids involving changes to the labia majora/minora, clitoris, vestibule/introitus, vagina, urethra and bladder.
Journal ArticleDOI
Long-term health consequences of premature or early menopause and considerations for management.
TL;DR: It is important to individualize hormone therapy for women with early estrogen deficiency, and higher dosages may be needed to approximate physiological concentrations found in premenopausal women.
Journal ArticleDOI
Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society.
David Portman,Margery Gass +1 more
TL;DR: The term genitourinary syndrome of menopause (GSM) is a medically more accurate, all-encompassing, and publicly acceptable term than vulvovaginal atrophy and is formally endorsed by the respective Boards of NAMS and ISSWSH in 2014.
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A Study of Sexuality and Health among Older Adults in the United States
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Review and re-analysis of domain-specific 16S primers
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Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial.
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