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Relief of Symptomatic Vulvovaginal Atrophy

Guideline Watch |
October 3, 2013

Relief of Symptomatic Vulvovaginal Atrophy

  1. Anne Moore, DNP, APN, FAANP

NAMS has developed a comprehensive approach to management.

  1. Anne Moore, DNP, APN, FAANP

The North American Menopause Society (NAMS) has released an updated position statement that addresses a common consequence of estrogen loss in menopausal women: vulvovaginal atrophy (VVA). Almost half of postmenopausal women have reported experiencing vaginal symptoms including dryness, irritation, and pain with intercourse, but very few understand the relation of these symptoms to menopause or discuss them with a healthcare provider. The NAMS statement includes information about the evaluation, diagnosis, and treatment of VVA.

Highlights of the recommendations are as follows:

  • First-line treatments for symptomatic VVA include lubricants and long-acting vaginal moisturizers.

  • For persistent or moderate-to-severe VVA, low-dose vaginal or systemic estrogen therapy represents standard treatment.

  • The recently approved oral selective estrogen-receptor modulator ospemifene may be used for dyspareunia.

  • Progestins are generally not indicated in the setting of low-dose vaginal estrogen (however, safety data beyond 1 year are lacking)

  • Whether or not vaginal estrogen is being used, vaginal spotting or bleeding in a postmenopausal woman with an intact uterus requires further evaluation.

Comment

Given that many women now live one third of their lives after menopause, their quality of life must be better recognized and addressed. This position statement provides a comprehensive approach to evaluation and management of vulvovaginal atrophy, a common and vexing problem. Although vaginal estrogen is most commonly prescribed for sexual discomfort caused by VVA, this class of medications also reduces urinary urgency and recurrent urinary tract infections associated with the condition. Accordingly, all women should be queried about vaginal symptoms and educated about VVA.

  • Disclosures for Anne Moore, DNP, APN, FAANP at time of publication Consultant / Advisory board Watson

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