Vaginal estrogen deficiency TOG 2018

Question 1

What is the impact of decreased oestrogen during menopause of POF on vaginal pH?

Answer 1

Increased 6-8 (from premenopausal 4-5) - making vagina more susceptible to infection

Question 2

Most common symptoms of vaginal estrogen deficiency?

Answer 2

Vaginal dryness 75%
Dysparunia 40%
Vaginal pruritus
Discharge

Urinary tract - frequency, urgency, nocturne, dysuria and incontience

Question 3

How common is recurrent UTI in PM women? Why?

Answer 3

20%
Atrophy of urothelium

Question 4

What to lubricants treat?

Answer 4

Short lasting, short term relief during intercourse

Question 5

Which lubricants can break down latex condoms?

Answer 5

Oil-based lubricant

Question 6

How do vaginal moisturisers work? What are their use?

Answer 6

Imitate natural sections by rehydrating the mucosal layer and adhering to the vaginal lining. Effects longer lasting.
Can be used for painful sexual intercoure but also symptomatic women.

Question 7

Are phytoestrogens helpful at alleviating symptoms of VVA?

Answer 7

Not if taken orally but isoflavone gel, similar effects to oestrogen
Caution with phytoestrogens for those who are CI to estrogen

Question 8

Advantages and disadvantages of vaginal oestrogen

Answer 8

Ad
Improves Sx without need for progesterone
Reverses physiological changes of menopause
Minimal systemic absorbtion

Disadvantage
- Caution in women with CI to oestrogen
- Benefit for as long as Tx continued

Question 9

Which selective estogen receptor modulators can be used in to treat VVA?
Ads & disads

Answer 9

Ospemifene
Lasofoxifene

Ads
- Effective treatment VVA and osteoporosis
- Can be used if CI to oestrogen

• More studies needed to assess safety for the endometrium with lasofocifene

Question 10

Advantages and disadvantages of androgens and DHEA

Answer 10

Can be given orally or vaginally
- Vaginal administration safe & effective
- Can improve labido
- minimal systemic absorbtion

Caution
- Relatively new treatment more safety data regarding systemic effect would be desirable

Question 11

Advantages and disadvantages laser treatment

Answer 11

Routine vaginal
- Preliminary prospective observational data shows benefit
- Caution if CI to estogen

Caution
- Long term data needed

Question 12

What is a tissue-selective estogen complex?

Answer 12

Combine conjugated estogens with a selective estrogen receptor modulator

Question 13

Advantages and disadvantaged of tissues selevtive estogen complex?

Answer 13

Advantage
- Can alleviate symptoms of vulvovaginal atrophy, hot flushes, bone loss
- Potenteional protective effects for breast and endometrium

Disadvantage
- New treatment, longer term data needed
- Only 1 dose of estrogen which may not be sufficient estogenic for some women