Clinical Efficacy of Hormonal and Nonhormonal Agents in the Treatment of Vulvovaginal Atrophy
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Objectives: Symptomatic local treatment of vaginal atrophy (VA) in menopausal women includes hormonal and nonhormonal preparations. Some women may be reluctant to use vaginal estradiol preparations because of the concern for developing breast cancer and endometrial hyperplasia. Therefore, it is necessary to compare the therapeutic effectiveness of alternative vaginal drugs, such as promestriene, an estrogen agonist, and sodium hyaluronate (NaH), a nonhormonal, water-based agent. Methods: Ninety-one postmenopausal women diagnosed with symptomatic VA were divided into three groups and treated for 12 weeks; 30 women with vaginal estradiol (VE), 30 women with promestriene, and 31 women with NaH. Composite scoring, vaginal maturation index (VMI), pH, frequency of sexual activity, serum hormone levels, and endometrial thickness were evaluated VA before and after treatment. Results: In the comparison of VA examination findings composite scoring, VMI, and vaginal pH values, three different drugs were found to be effective in the treatment (P < 0.05). The VMI following VE treatment was significantly higher than that after NaH treatment (P = 0.031), whereas the promestriene group had a more positive change than the others in terms of increase in after treatment composite scoring and sexual activity frequency (P = 0.031, P = 0.020). There were no differences between the groups in terms of pre and after treatment serum E2 levels and endometrial thickness. Conclusions: Based on these findings, we can conclude that the use of promestriene or NaH can prove to be as effective and well tolerated as vaginal estradiol in the symptomatic treatment of vaginal atrophy.
Abstract
Objectives: Symptomatic local treatment of vaginal atrophy (VA) in menopausal women includes hormonal and nonhormonal preparations. Some women may be reluctant to use vaginal estradiol preparations because of the concern for developing breast cancer and endometrial hyperplasia. Therefore, it is necessary to compare the therapeutic effectiveness of alternative vaginal drugs, such as promestriene, an estrogen agonist, and sodium hyaluronate (NaH), a nonhormonal, water-based agent. Methods: Ninety-one postmenopausal women diagnosed with symptomatic VA were divided into three groups and treated for 12 weeks; 30 women with vaginal estradiol (VE), 30 women with promestriene, and 31 women with NaH. Composite scoring, vaginal maturation index (VMI), pH, frequency of sexual activity, serum hormone levels, and endometrial thickness were evaluated VA before and after treatment. Results: In the comparison of VA examination findings composite scoring, VMI, and vaginal pH values, three different drugs were found to be effective in the treatment (P < 0.05). The VMI following VE treatment was significantly higher than that after NaH treatment (P = 0.031), whereas the promestriene group had a more positive change than the others in terms of increase in after treatment composite scoring and sexual activity frequency (P = 0.031, P = 0.020). There were no differences between the groups in terms of pre and after treatment serum E2 levels and endometrial thickness. Conclusions: Based on these findings, we can conclude that the use of promestriene or NaH can prove to be as effective and well tolerated as vaginal estradiol in the symptomatic treatment of vaginal atrophy.
참고문헌 (27)
- Nappi RE, "Women's voices in the menopause : results from an international survey on vaginal atrophy", Maturitas, 67, pp.233~238 (2010)
- Portman DJ, "Genitourinary syndrome of menopause:new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society", J Sex Med, 11, pp.2865~2872 (2014)
- Chin SN, "Prevalence and severity of urogenital symptoms in postmenopausal women receiving endocrine therapy for breast cancer", Clin Breast Cancer, 9, pp.108~117 (2009)
- Faubion SS, "Genitourinary syndrome of menopause : management strategies for the clinician", Mayo Clin Proc, 92, pp.1842~1849 (2017)
- "Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society", Menopause, 20, pp.888~902 (2013)
- Kokot-Kierepa M, "Local estrogen therapy--clinical implications--2012 update", Ginekol Pol, 83, pp.772~777 (2012)
- Simunić V, "Local estrogen treatment in patients with urogenital symptoms", Int J Gynaecol Obstet, 82, pp.187~197 (2003)
- Crandall C, "Association of breast cancer and its therapy with menopause-related symptoms", Menopause, 11, pp.519~530 (2004)
- Rosenberg SM, "Premature menopause in young breast cancer : effects on quality of life and treatment interventions", J Thorac Dis, 5(Suppl 1), pp.S55~S61 (2013)
- Lethaby A, "Local oestrogen for vaginal atrophy in postmenopausal women", Cochrane Database Syst Rev, 2016, pp.CD001500~ (2016)
- Rioux JE, "17β-estradiol vaginal tablet versus conjugated equine estrogen vaginal cream to relieve menopausal atrophic vaginitis", Menopause, 25, pp.1208~1213 (2018)
- Mehta A, "Vulvovaginal complaints", Clin Obstet Gynecol, 51, pp.549~555 (2008)
- Bachmann GA, "Diagnosis and treatment of atrophic vaginitis", Am Fam Physician, 61, pp.3090~3096 (2000)
- Castelo-Branco C, "Management of post-menopausal vaginal atrophy and atrophic vaginitis", Maturitas, 52(Suppl 1), pp.S46~S52 (2005)
- Bachmann G, "Efficacy of low-dose estradiol vaginal tablets in the treatment of atrophic vaginitis : a randomized controlled trial", Obstet Gynecol, 111, pp.67~76 (2008)
- Meisels A, "The maturation value", Acta Cytol, 11, pp.249~ (1967)
- Jaisamrarn U, "Ultra-low-dose estriol and lactobacilli in the local treatment of postmenopausal vaginal atrophy", Climacteric, 16, pp.347~355 (2013)
- Iosif CS, "Estrogen receptors in the human female lower uninary tract", Am J Obstet Gynecol, 141, pp.817~820 (1981)
- Chung da J, "Roles of sex steroid receptors and cell cycle regulation in pathogenesis of pelvic organ prolapse", Curr Opin Obstet Gynecol, 18, pp.551~554 (2006)
- Lee YK, "Vaginal pH-balanced gel for the control of atrophic vaginitis among breast cancer survivors : a randomized controlled trial", Obstet Gynecol, 117, pp.922~927 (2011)
- Ekin M, "The comparison of hyaluronic acid vaginal tablets with estradiol vaginal tablets in the treatment of atrophic vaginitis : a randomized controlled trial", Arch Gynecol Obstet, 283, pp.539~543 (2011)
- Del Pup L, "Management of vaginal dryness and dyspareunia in estrogen sensitive cancer patients", Gynecol Endocrinol, 28, pp.740~745 (2012)
- Sun AJ, "Safety of promestriene capsule used in postmenopausal atrophic vaginitis", Zhonghua Fu Chan Ke Za Zhi, 44, pp.593~596 (2009)
- Del Pup L, "Effect of one-month treatment with vaginal promestriene on serum estrone sulfate levels in cancer patients : a pilot study", Maturitas, 72, pp.93~94 (2012)
- Grimaldi EF, "Role of high molecular weight hyaluronic acid in postmenopausal vaginal discomfort", Minerva Ginecol, 64, pp.321~329 (2012)
- Naumova I, "Current treatment options for postmenopausal vaginal atrophy", Int J Womens Health, 10, pp.387~395 (2018)
- Simon J, "Endometrial safety of ultra-low-dose estradiol vaginal tablets", Obstet Gynecol, 116, pp.876~883 (2010)