Management Of Symptomatic Vulvovaginal Atrophy

Publication Date: September 1, 2013

CONCLUSIONS AND RECOMMENDATIONS

First-line therapies for women with symptomatic VVA include nonhormonal lubricants with intercourse and, if indicated, regular use of long-acting vaginal moisturizers. (Level I)
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For symptomatic women with moderate to severe VVA and for those with milder VVA who do not respond to lubricants and moisturizers, estrogen therapy either vaginally at low dose or systemically remains the therapeutic standard. Low-dose vaginal estrogen is preferred when VVA is the only menopausal symptom. (Level I)
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Ospemifene is another option for dyspareunia. (Level I)
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For women with a history of breast or endometrial cancer, management depends on a woman_s preference, need, understanding of potential risks, and consultation with her oncologist. (Level III)
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Estrogen therapy carries a class effect risk of VTE. Lowdose vaginal estrogen may carry a very low risk, but there has been no report of an increased risk in the vaginal estrogen clinical trials. Data in high-risk women are lacking. (Level III)
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A progestogen is generally not indicated when low-dose vaginal estrogen is administered for symptomatic VVA. Endometrial safety data are not available for use longer than 1 year. (Level II)
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If a woman is at high risk of endometrial cancer or is using a higher dose of vaginal ET, transvaginal ultrasound or intermittent progestogen therapy may be considered. There are insufficient data to recommend routine annual endometrial surveillance in asymptomatic women using vaginal ET. (Level III)
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Spotting or bleeding in a postmenopausal woman who has an intact uterus requires a thorough evaluation that may include transvaginal ultrasound and/or endometrial biopsy. (Level I)
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For women treated for non-hormone-dependent cancer, management of VVA is similar to that for women without a cancer history. (Level II)
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Vaginal ET or ospemifene, with appropriate clinical surveillance, can be continued as long as bothersome symptoms are present. (Level III)
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Proactive education on vaginal health is recommended for postmenopausal women. (Level III)
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Recommendation Grading

Disclaimer

Overview

Title

Management Of Symptomatic Vulvovaginal Atrophy

Authoring Organization

Publication Month/Year

September 1, 2013

Supplemental Implementation Tools

Document Type

Consensus

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Adult, Older adult

Health Care Settings

Ambulatory, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D008593 - Menopause, D017698 - Postmenopause, D047648 - Perimenopause

Keywords

menopause, vulvovaginal atrophy (VVA), vaginal dryness, Ospemifene, Dyspareunia, vaginal estrogen