Pharmacological and non-pharmacological treatment modalities for the genitourinary syndrome of menopause
| Pharmacological treatment | Non-pharmacological treatment |
|---|---|
| Hormone therapy | Lifestyle changes |
| SERM | Vaginal lubricants |
| DHEA | Vaginal moisturizers |
| Testosteron | Laser therapy |
| Lidocain | Vaginal dilatators |
Genital, urinary, and sexual signs and symptoms of genitourinary syndrome of menopause
| Genital | Urinary | Sexual |
|---|---|---|
| Vaginal dryness | Dysuria | Dyspareunia |
| Vaginal irritation | Urgency | Decreased lubrication |
| Vaginal burning | Frequency | Postcoital bleeding and spotting |
| Vaginal itching | Reccurent urinary tract infections | Decreased arousal |
| Vulvar pruritus | Cystocele | Dysorgasmia |
| Thinning and graying pubic hair | Stress urinary incontinence | Loss of libido |
| Vaginal/pelvic pain and pressure | Urge urinary incontinence | Loss of arousal |
| Vaginal vault prolapse | Hematuria | Pelvic pain |
| Vaginal and introital stenosis | Nocturia | |
| Palor of vaginal mucosa | ||
| Fewer vaginal rugae | ||
| Petechiae in vaginal and cervical mucosa | ||
| Labial shrinking and atrophia |
Recommendations for hormone therapy in women treated for gynecological malignancies
| Gynecological malignancy | Recommendation | Selected articles | Level of evidence | Note |
|---|---|---|---|---|
| Uterine cancer | ||||
| Early stage endometrial cancer | HT acceptable | Barakat et al. 200631 | randomized control trial | 1236 patients, no difference in recurrence rate with the use of HT |
| Shim et al. 201432 | meta-analysis | no increased risk of recurrence | ||
| Advanced stage endometrial cancer | HT not recommended | Sinno et al. 20202 | NAMS clinical practice statement | no data supporting use of HT |
| Uterine sarcoma | HT not recommended | George et al. 201421 | phase 2 trial | 27 patients, a potential response to anti-estrogen therapy (Letrozole) |
| Sinno et al. 20202 | NAMS clinical practice statement | lack of data regarding HT safety | ||
| Ovarian cancer | ||||
| High grade serous | HT acceptable | Li et al. 201533 | meta-analysis | HT is not associated with poorer clinical outcome, epithelial ovarian cancers |
| Low grade serous | HT not recommended | Gershenson et al. 201234 | retrospective study | 64 patients, high rate of hormone receptor expression and maintenance anti-endocrine therapy |
| Sinno et al. 20202 | NAMS clinical practice statement | not sufficient safety data available | ||
| Endometrioid | HT acceptable | Power et al. 201635 | retrospective cohort data | 391 patients, HT is not associated with decreased disease-free or overall survival |
| Clear cell | HT not recommended | Didar et al. 202322 | meta-analysis | increased risk of venous thromboembolism events |
| Mucinous | HT acceptable | Li et al. 201533 | meta-analysis | HT is not associated with poorer clinical outcome, epithelial ovarian cancers |
| Cervical cancer | HT acceptable | Ploch et al. 198736 | prospective study | 120 patients, no difference in recurrence rate with the use of HT |