A systematic review describes pros and cons of the various available options.
Genitourinary syndrome of menopause (GSM) encompasses the signs and symptoms resulting from loss of estrogen and, to a lesser extent, androgen in the genitourinary tract. The emergence of a variety of nonhormonal local and systemic options to treat patients with GSM prompted this systematic review of vaginal moisturisers, vaginal estrogen and nonestrogen hormone therapies.
The 46 randomised trials included in this review predominantly involved healthy white female participants in their 50s with moderate-to-severe genitourinary symptoms. Most studies were three months or less in duration, which precluded evaluation of long-term safety, and no studies were powered to detect infrequent harms. This literature review provided low-certainty evidence of the following:
- both vaginal moisturisers and vaginal estrogens were more effective than placebo at improving symptoms of vulvovaginal dryness, but both classes were of uncertain benefit for dyspareunia
- both vaginal dehydroepiandrosterone (DHEA) and oral ospemifene (a selective estrogen-receptor modulator) were more effective than placebo for both vulvovaginal dryness and dyspareunia
- no treatment was found to be more effective than placebo for urinary symptoms
- vaginal testosterone, vaginal oxytocin, oral DHEA, oral raloxifene and oral bazedoxifene were of uncertain benefit for managing any GSM symptom.
Comment: Local estrogen does seem to provide good relief in practice, particularly for patients with lesssevere GSM symptoms, even when dyspareunia is among the bothersome symptoms. Although both vaginal DHEA and oral ospemifene were more effective than placebo for vaginal dryness and dyspareunia, their costs (average whole sale cost, about US$10 [about A$15] daily) and limited long-term safety data limit the acceptability of these options for many patients.
Marie Claire O’Dwyer, MB BCh BAO, MPH, Clinical Assistant Professor in Family Medicine, University of Michigan Medical School, Ann Arbor, USA.
Danan ER, et al. Hormonal treatments and vaginal moisturizers for genitourinary syndrome of menopause: a systematic review. Ann Intern Med 2024; 177: 1400-1414.
Ullman KE, et al. Complementary and alternative therapies for genitourinary syndrome of menopause: an evidence map. Ann Intern Med 2024; 177: 1389-1399.
This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Women’s Health.