Advances in the Treatment of Vulvovaginal Atrophy

Jill M Krapf; Zoe R Belkin; Andrew T Goldstein


Expert Rev of Obstet Gynecol. 2013;8(5):457-465. 

In This Article

Five-year View

Vaginal estrogens have been the staple treatment for vulvovaginal atrophy for many years and research shows increasingly reassuring evidence for safety of local estrogens' application. Over time, studies have shown a trend toward lower doses of local estrogens. Nevertheless, concern over long-term safety of exogenous hormones has led to the development of many alternative options.

SERMs, with or without estrogens, are an exciting area of research for treatment of vulvovaginal atrophy, and other menopausal symptoms. Ospemifene's (Osphena) recent FDA approval for treatment of moderate to severe dyspareunia demonstrates progress in awareness and treatment of overlooked and ignored symptoms of menopause. Similarly, TSECs, which strive to address multiple menopausal symptoms, including hot flushes, vulvovaginal atrophy and bone loss, while still protecting the uterus and breast, serve as hopeful options for the future. Specifically, BZA/CE holds promise in reaching this goal.

In the past, treatment choices for vulvovaginal atrophy in the setting of breast cancer were limited to lubricants and vaginal moisturizers. With the exploration of SERMs, local androgens, oxytocin and vaginal pH-balanced gels, there will be many more safe options for women who cannot or choose not to take estrogen therapy. Development of these novel treatment prospects, and in particular the use of androgens and DHEA, may provide meaningful benefits to sexual function as well.

In May 2013 The International Society for the Study of Women's Sexual Healthy and the North American Menopause Society held a vulvovaginal atrophy consensus conference where female reproductive health experts in gynecology, urology, endocrinology, reproductive endocrinology, urogynecology, gynecological pathology and internal medicine from multiple sites met to provide direction in current and future treatment of vulvovaginal atrophy. The goals of the conference were to review basic and clinical scientific evidence on vulvovaginal atrophy, define key factors that influence diagnosis, treatment and patient management, and develop a revised lexicon and nomenclature for vulvovaginal atrophy.

With so many new and promising approaches to treat vulvovaginal atrophy, it is necessary to educate clinicians on the importance of identifying and addressing these often neglected symptoms of menopause. Furthermore, clinicians must be reassured of the safety and efficacy of local estrogen preparations, as well as of newer therapies as they become available.