Genitourinary syndrome of menopause: Common problem, effective treatments

Article Figures & Data

TABLE 1

Genitourinary syndrome of menopause: Clinical symptoms

Vulvovaginal dryness, itching, burning, irritation

Vaginal discharge

Decreased lubrication or arousal with sexual activity

Pain with introital insertion during sexual activity (dyspareunia)

Decreased or delayed orgasm

Postcoital bleeding

Dysuria

Urinary frequency or urgency

Recurrent urinary tract infections

TABLE 3

Nonhormonal causes of genitourinary symptoms

Conditions	Associated symptoms
Medical problems
Sexually transmitted infections	Vaginal discharge, odor, irritation
Candidiasis
Bacterial vaginosis
Trichomoniasis
Lichen sclerosis	Hypopigmented, waxy, agglutination, loss of labial folds
Lichen planus	Red plaques, pain
Lichen simplex chonicus	Lichenified skin
Vulvar intraepithelial neoplasm	Raised or eroded lesions
Vulvar cancer	Ulcer with raised edges
Paget disease	Red, scaly plaque with sharp border
Vulvodynia	Dyspareunia
Vaginismus	Dyspareunia
Psoriasis, eczema	Multiple plaque-like lesions, nongenital lesions
Inflammatory bowel disease	Fissures
Skin irritants
Perfumes Powders	Contact dermatitis, skin irritation, reactions
Deodorants
Soaps
Spermicides
Lubricants
Hot tub and pool additives
Foreign bodies
Panty liners
Perineal pads
Tight-fitting or synthetic clothing
Retained foreign body

TABLE 4

FDA-approved preparations for vulvovaginal atrophy

Product	Proprietary name	Dosing
Vaginal creams
17-beta estradiol	Estrace vaginal cream 0.1 mg/g	Initial: 2–4 g/day for 1–2 weeks Maintenance: 1 g at 1–3 times a week^a
Conjugated estrogens	Premarin vaginal cream^b (0.625 mg/g)	Vulvovaginal atrophy: 0.5–2 g/d for 21 days, then off 7 days or twice a week^a Dyspareunia: 0.5 g/day for 21 days, then off 7 days or twice a week^a
Vaginal ring
17-beta estradiol	Estring (7.5 μg/day)	Inserted for 90-day intervals without interruption
Estradiol acetate	Femring (5 and 10 μg/day)
Vaginal tablet inserts
Estradiol hemihydrate	Vagifem, Yuvafem^c (10 μg/day)	Initial: 1 tablet/day for 2 weeks Maintenance: 1 tablet twice a week
DHEA (prasterone)	Intrarosa (6.5 mg insert)	1 insert into vagina, once daily
Oral tablet
Ospemifene	Osphena (60 mg)	1 tablet orally every day

↵a Common clinical dosage is 0.5 g twice a week for maintenance.
↵b Premarin vaginal cream is the only locally applied preparation with FDA approval for dyspareunia due to GSM.
↵c Yuvafem is an FDA-approved generic equivalent to Vagifem.
DHEA = dehydroepiandrosterone; FDA = US Food and Drug Administration