Kate Johnson

October 04, 2013

DALLAS — When TV doctor Miranda Bailey was not allowed to say "vagina" on the air, the producers of Grey's Anatomy catapulted "vajayjay" into popular lingo, thereby lubricating uncomfortable conversations about female genitalia across all age groups, from kindergarten to the geriatrics ward.

Gynecologists at the North American Menopause Society (NAMS) 2013 Annual Meeting, being held October 9 to 12 in Dallas, hope to hit a similar language jackpot as they struggle to make it easier to talk about vulvovaginal atrophy.

"There's a push to try to rename this syndrome, with new, objective terminology for the vagina, vulva, and bladder," Risa Kagan, MD, chair of the NAMS scientific program committee, told Medscape Medical News.

"The print media, TV, advertisers, and women don't like the sound of vulvovaginal atrophy. Whenever you mention it to patients, they just cringe. People don't want to talk about it," said Dr. Kagan, who is a clinical professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco, in Berkeley.

By book-ending the conference with this topic — it will be addressed during the premeeting symposium and plenary symposium 9 on the final day of the meeting — organizers hope to encourage delegates to come up with new nomenclature and standardized staging for vulvovaginal atrophy, and to have more open discussions with their patients about the condition, Dr. Kagan explained.

"Even though we have good treatments for vulvovaginal atrophy, what's come out of numerous surveys is that physicians don't ask about it and patients don't talk about it," she said.

Women don't like the sound of vulvovaginal atrophy. Whenever you mention it to patients, they just cringe.

While encouraging wider public acceptance of vulvovaginal care and treatments, NAMS organizers will be aiming to reign in the public and media interest in another aspect of menopause: bioidentical compounded hormones (plenary symposium 11).

"This is so controversial that we think it's important to bring this topic to the forefront," said Dr. Kagan. She explained that the idea for the meeting's final event — a panel discussion featuring opposing viewpoints on compounding — was sparked by last year's fungal meningitis outbreak and its link to compounded epidural steroids.

Menopause specialists watched that tragedy unfold with renewed concern about their own patients, said Dr. Kagan.

"There are people out there using compounded gels, creams, tablets, and thinking they are taking medication that is safer than what I would give them," she said. NAMS, the Endocrine Society, and the American College of Obstetricians and Gynecologists have all issued joint statements condemning compounding, she added.

"Patients are vulnerable because women do not know who to trust or believe," she noted.

During the panel discussion, Erika Schwartz, MD, an advocate of compounding and founding director of the Bioidentical Hormone Initiative, will explain her support of the practice, and several NAMS representatives will offer counter arguments.

"It'll be a hot debate," promised Dr. Kagan, adding that questions will be presubmitted, rather than invited from the floor, to "keep the temperature down."

Hot Flashes

Because temperature control is such a preoccupation for menopause, hot flashes will be extensively discussed at the meeting (plenary symposium 2), with a specific focus on alternatives to estrogen therapy, said Dr. Kagan.

"Estrogen has been the gold standard for hot flash treatment, and there's no question that it is the best therapy for hot flashes. But, as we all know, there are many women who refuse to take hormone therapy, can't take hormone therapy, or are so afraid to take hormone therapy that they suffer," she said.

NAMS will be featuring 13 presentations on low-dose paroxetine mesylate (Brisdelle, Noven Therapeutics), she noted. In June, it became the first nonhormonal treatment for hot flashes to be approved by the US Food and Drug Administration.

Updates from the ELITE, MsFLASH-3, and KEEPS trials have also been promised.


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