The vagina: therapeutic role of estrogens

The vagina: therapeutic role of estrogens

Anna Maria Paoletti– Orcid , Manuela Neri2

1 – Full Professor of Gynecology and Obstetrics, University of Cagliari

2- Medical Director at the Gynecological Oncology Division of the Oncology Hospital of Cagliari, Brotzu Hospital (AOB)

Corresponding author: Anna Maria Paoletti

annapaoletti@unica.it


DOI: 10.53146/lriog1202125

Abstract

Estrogen plays a key role in the physiology of the vagina. The multi-layering of the vaginal epithelium is regulated by estrogen, as well as the function of the cervical glands, connective trophism, vascularization and the local immune system itself. All conditions of hypoestrogenism, be they physiological such as menopause, the menopausal transition period, the puerperium and jatrogens as treatments for estrogen dependent diseases, but also the use of hormonal contraceptives containing only progestin or low doses of ethinylestradiol are risk factors for atrophy of vagina and urinary tract, which is also modulated by estrogen. In all conditions of hypoestrogenism, detectable by a correct medical history, the Gynecologist must ask specific questions about the specific symptoms both in the fertile age and after the menopause, focusing on the genitourinary syndrome. A careful examination must make a differential diagnosis with dermatological or autoimmune diseases, and evaluate the intensity of the problem with internationally validated scales. Once the diagnosis has been established and contraindications to the use of estrogen have been excluded, the first-line treatment is the use of vaginal estrogens, such as estriol, estradiol or promestriene and conjugated estrogens. The proposed treatment must be monitored at regular intervals to assess its effectiveness, safety and acceptability.

Keywords: genitourinary syndrom; ospemifene; dyspareunia; vulvar atrophy; vaginal atrophy; dysuria.


Available in LRIOG Nr.2 – 2021

e-ISSN: 1824-0283


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The vagina: therapeutic role of ospemifene

La vagina: ruolo terapeutico dell’ospemifene

Novella Russo – Orcid

Demetra Medical Center: Center for Menopause

novella_russo@virgilio.it


DOI: 10.53146/lriog1202124

Abstract

The Genitourinary Syndrome of Menopause (GSM) is a progressive chronic condition that can be very bothersome for women. This disease, mainly due to the endocrinological changes occurring with menopause, is characterized by symptoms such as vaginal dryness, dyspareunia, itching, burning and dysuria. The marketing of a relatively new drug, Ospemifene, for the treatment of this clinical condition has given a new therapeutic option and prospective for a better quality of life in women affected by VulvoVaginal Atrophia (VVA). Ospemifene is a Selective Estrogen Receptor Modulator (SERM) and can also be prescibed to women with a history of breast cancer. The oral route of administration has shown to give higher adherence to treatment being preferable for many women to the vaginal route with a high satisfaction rate. In this article the main characteristics of the effects of Ospemifene on GSM have been elucidated and some of the most interesting studies have been illustrated. Women’s wording has been reported and particular attention given to their personal and familiar histories. Objective vulvar examination is described and aspects to be analysed in deep are reported. Therapeutic suggestions of a multimodal approach to the disease are made, although on this matter further scientific studies showing solid data are needed.

Keywords: genitourinary syndrom; ospemifene; dyspareunia; vulvar atrophy; vaginal atrophy; dysuria.


Available in LRIOG Nr.2 – 2021

e-ISSN: 1824-0283


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Androgens and genitourinary syndrome of the menopause

Androgens and genitourinary syndrome of the menopause. Why, when and for whom they could be indicated

Alessandra Graziottin – Orcid

Director of the  Gynecology and Medical Sexology Center, H. San Raffaele Resnati, Milan

Alessandra Graziottin Foundation for the treatment of pain in women – Onlus

direzione@studiograziottin.it


DOI: 10.53146/lriog120212

Abstract

Why androgens – testosterone and dehydroepiandrosterone (DHEA) – can play a role in the treatment of the Genitourinary Syndrome of the Menopause? What evidence supports this? Androgens are essential sex hormones for women’s health. Biological evidence (“bio-evidence”) indicates the following: androgens reach high plasma levels in childbearing age; have cell receptors in major organs; the hormone-receptor interaction mediates androgen-mediated, somatic (brain, muscle, bone), sexual and reproductive functions; their deficiency causes symptoms of androgenic insufficiency. They have a trophic, sexual, anti-inflammatory, and reconstructive functions. DHEA launches puberty (adrenarche). Androgens reach their plasma peak at twenty years of age, then they undergo an age-dependent gradual fall. At the age of fifty, women have lost about 50% of testosterone and 60-70% of DHEA. Bilateral ovariectomy reduces testosterone by 80%. Their age-
dependent reduction, worsened by estrogen deficiency, contributes to systemic and genital aging and to the “low grade inflammation” typical of post-menopause. Genitourinary Syndrome of the Menopause includes vulvo-vaginal symptoms.

Keywords: androgens; prasterone; testosterone; genitourinary syndrome of the menopause (GSM).


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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