By Anne Harding
NEW YORK (Reuters Health) Sep 04 - Clinicians should ask their peri- and postmenopausal patients about whether they are experiencing symptoms of vulvovaginal atrophy (VVA), the North American Menopause Society (NAMS) advises in a new position statement.
These symptoms can be treated with a variety of over-the-counter (OTC) and prescription products, and in most cases can be managed successfully, the statement says.
The new document, published in NAMS' journal Menopause, updates the society's 2007 statement on the use of local vaginal estrogen for treating VVA to include several other available therapies, including ospemifene (Shionogi), a novel selective estrogen receptor modulator targeting the vaginal area that the Food and Drug Administration approved in April 2013 for treating dyspareunia
Up to 45% of postmenopausal women experience VVA symptoms, "but only a minority seek help or are offered help by their providers," according to the statement.
Some degree of VVA is inevitable with aging, Dr. Margery Gass, the president of NAMS, told Reuters Health. "Menopause is a natural part of a woman's life, it's normal and natural, but there are certain changes in the body that are good to be aware of," Dr. Gass said. "A lot of women have never really been informed of them, and sometimes women just learn about them by accident when they run into problems."
Symptoms of VVA can include dryness, vulval irritation, burning, dysuria, dyspareunia, and vaginal discharge, according to the NAMS statement. First-line therapies should include OTC vaginal lubricants and moisturizers, "as well as regular sexual activity with partner, device, or solo," the statement says.
Maintaining sexual activity is important, Dr. Gass noted, because it can help slow VVA. "We find some of the more severe problems in women who have been abstinent for a long time," she said. "It's very important if women want to retain the ability to have intercourse that they continue to have sexual activity on a regular basis. Those women who do continue sexual activity typically have fewer problems."
No herbal product has been shown to be effective for treating VVA, according to the statement.
Other treatment options addressed in the statement include vaginal estrogen, which is available in several forms and has been shown to be helpful for 80% to 90% of patients; ospemifine; and several investigational therapies. Local estrogen is preferable to systemic estrogen for women whose only menopausal symptoms is VVA, according to the group.
Reuters Health Information © 2013