The vagina: therapeutic role of prasterone

The vagina: therapeutic role of prasterone

Linda Vignozzi1,2 – Orcid, Irene Scavello1 – Orcid, Elisa Maseroli1 – Orcid, Vincenzo Di Stasi– Orcid, Sarah Cipriani1,2 – Orcid

1 – Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, University of Florence

2 – SODc Andrology, Female Endocrinology and Gender Incongruence, Careggi University Hospital, Florence

Corresponding author: Linda Vignozzi

linda.vignozzi@unifi.it


DOI: 10.53146/lriog1202123

Abstract

Genitourinary menopause syndrome (GSM) is a chronic, progressive condition, which results from the effects of estrogenic and androgenic deficiency typical of menopausal age. It involves the genitourinary district and occurs with an extremely wide range of signs and symptoms. Dyspareunia, both superficial and deep, is among the main and most distressing symptoms of the GSM. Over the decades, different therapeutic approaches have been developed, aimed at improving the symptomatology and thus the quality of life of women, such as local estrogenic therapy, which until now has been considered the gold standard of GSM treatment. A new Prasterone formulation has recently been approved, which is biochemically and biologically identical to that of the endogenous human DHEA, an inactive steroid precursor that can be converted into estrogen and androgen into vaginal cells. The rationale of the use of prasterone is the theory of intracrinology, which is the proven ability of vaginal cells to convert an inactive compound into an active form. This molecule, absorbed locally, determines only a minimum increase in circulating hormonal values, which remains be- low the threshold of physiologic levels for menopausal women.

Keywords: prasterone; genitourinary syndrome; menopause; atrophy.


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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