An evaluation of the safety and effectiveness of local vaginal estrogen therapy for the treatment of vaginal atrophy, a frequent complaint of postmenopausal women, has just been released by The North American Menopause Society (NAMS). Entitled "The role of local vaginal estrogen for treatment of vaginal atrophy in postmenopausal women: 2007 position statement of The North American Menopause Society," the document was developed by an Editorial Board of five clinicians and researchers expert in this area of women's health, then approved by the NAMS Board of Trustees.
"Although hot flashes typically accompany the loss of ovarian estrogen production at menopause, they usually abate over time regardless of whether estrogen therapy is used," said Gloria A. Bachmann, MD, Associate Dean for Women's Health, Professor of Obstetrics and Gynecology and Professor of Medicine, UMDNJ, Robert Wood Johnson Medical School, New Brunswick, NJ, and Chair of the Editorial Board. "In contrast, vaginal symptoms (eg, vaginal dryness, vulvovaginal irritation and itching, and painful intercourse) are usually progressive and unlikely to resolve spontaneously. Left untreated, vaginal atrophy can result in years of discomfort, with a significant impact on quality of life. An estimated 10% to 40% of postmenopausal women have symptoms related to vaginal atrophy, yet only about 25% of symptomatic women seek medical help."
The new position statement represents the most authoritative state-of-the-science summary. Significant findings include:
-- Estrogen therapy, used either locally (ie, vaginally) or systemically (eg, orally, through the skin), is considered the therapeutic standard for moderate to severe vaginal atrophy.
-- Local vaginal delivery of estrogen is available in North America in government-approved therapies via cream, tablet, and ring--with fewer systemic effects than estrogen by topical, parenteral, or oral delivery.
-- Randomized controlled trials, although limited, have shown that low-dose, local vaginal estrogen delivery is effective and well tolerated for treating vaginal atrophy.
-- All the low-dose vaginal estrogen products approved in the United States for treatment of vaginal atrophy are equally effective at the doses recommended in labeling. Choice of therapy should be guided by clinical experience and patient preference.
-- Progestogen is generally not indicated when low-dose estrogen is used locally for vaginal atrophy.
-- Data are insignificant to recommend annual surveillance of the endometrium (lining of uterus) in asymptomatic women using vaginal estrogen.
-- Vaginal estrogen therapy should be continued for as long as symptoms that are distressing to the patient remain.
-- For women treated for non-hormone-dependent cancer, management of vaginal atrophy is similar to that for women without a cancer history.
-- For women with a history of hormone-dependent cancer, management recommendations are dependent upon each woman's preference in consultation with her oncologist.
The position statement is published in the May/June 2007 issue of the Society's official journal, Menopause. It has been designated a NAMS CME activity (print/online). A PDF of the paper, as well as a set of nine slides that summarize the paper's contents, are available without charge from the NAMS Web site (http://www.menopause.org/aboutmeno/consensus.htm).
NAMS is grateful to Novo Nordisk, Inc., for its educational grant that supported development of this statement.
The Mission of NAMS, a nonprofit scientific organization, is to promote the health and quality of life of women through an understanding of menopause. The Society's membership of 2,000 professionals representing a variety of disciplines--including clinical and basic science experts from medicine, nursing, pharmacy, anthropology, sociology, psychology, and complementary/alternative medicine--makes NAMS uniquely qualified to serve as the definitive resource for health professionals and the public for accurate, unbiased information about menopause. (www.menopause.org)
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"Although hot flashes typically accompany the loss of ovarian estrogen production at menopause, they usually abate over time regardless of whether estrogen therapy is used," said Gloria A. Bachmann, MD, Associate Dean for Women's Health, Professor of Obstetrics and Gynecology and Professor of Medicine, UMDNJ, Robert Wood Johnson Medical School, New Brunswick, NJ, and Chair of the Editorial Board. "In contrast, vaginal symptoms (eg, vaginal dryness, vulvovaginal irritation and itching, and painful intercourse) are usually progressive and unlikely to resolve spontaneously. Left untreated, vaginal atrophy can result in years of discomfort, with a significant impact on quality of life. An estimated 10% to 40% of postmenopausal women have symptoms related to vaginal atrophy, yet only about 25% of symptomatic women seek medical help."
The new position statement represents the most authoritative state-of-the-science summary. Significant findings include:
-- Estrogen therapy, used either locally (ie, vaginally) or systemically (eg, orally, through the skin), is considered the therapeutic standard for moderate to severe vaginal atrophy.
-- Local vaginal delivery of estrogen is available in North America in government-approved therapies via cream, tablet, and ring--with fewer systemic effects than estrogen by topical, parenteral, or oral delivery.
-- Randomized controlled trials, although limited, have shown that low-dose, local vaginal estrogen delivery is effective and well tolerated for treating vaginal atrophy.
-- All the low-dose vaginal estrogen products approved in the United States for treatment of vaginal atrophy are equally effective at the doses recommended in labeling. Choice of therapy should be guided by clinical experience and patient preference.
-- Progestogen is generally not indicated when low-dose estrogen is used locally for vaginal atrophy.
-- Data are insignificant to recommend annual surveillance of the endometrium (lining of uterus) in asymptomatic women using vaginal estrogen.
-- Vaginal estrogen therapy should be continued for as long as symptoms that are distressing to the patient remain.
-- For women treated for non-hormone-dependent cancer, management of vaginal atrophy is similar to that for women without a cancer history.
-- For women with a history of hormone-dependent cancer, management recommendations are dependent upon each woman's preference in consultation with her oncologist.
The position statement is published in the May/June 2007 issue of the Society's official journal, Menopause. It has been designated a NAMS CME activity (print/online). A PDF of the paper, as well as a set of nine slides that summarize the paper's contents, are available without charge from the NAMS Web site (http://www.menopause.org/aboutmeno/consensus.htm).
NAMS is grateful to Novo Nordisk, Inc., for its educational grant that supported development of this statement.
The Mission of NAMS, a nonprofit scientific organization, is to promote the health and quality of life of women through an understanding of menopause. The Society's membership of 2,000 professionals representing a variety of disciplines--including clinical and basic science experts from medicine, nursing, pharmacy, anthropology, sociology, psychology, and complementary/alternative medicine--makes NAMS uniquely qualified to serve as the definitive resource for health professionals and the public for accurate, unbiased information about menopause. (www.menopause.org)
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