Systematic review finds 3 medications with potential to treat vaginal symptoms of GSM in menopause

Systematic review finds 3 medications with potential to treat vaginal symptoms of GSM in menopause

Review: https://www.acpjournals.org/doi/10.7326/ANNALS-24-00610

Evidence Map: https://www.acpjournals.org/doi/10.7326/ANNALS-24-00603

URL goes live when the embargo lifts     

A systematic review of existing literature on genitourinary syndrome of menopause (GSM) treatments found that vaginal estrogen, vaginal DHEA, oral ospemifene, and vaginal moisturizers may improve some GSM symptoms in the short term. However, few long-term data exist on efficacy, comparative effectiveness, tolerability, and safety of GSM treatments. The review is published in the Annals of Internal Medicine.

Researchers from the Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System and the Agency for Healthcare Research and Patient-Centered Outcomes Research Institute studied data from postmenopausal women with at least 1 GSM symptom, such as dryness of the vulvar or vaginal area, urgency or pain with urination, pain with intercourse, or decreased libido. Based on a search of 3 databases, researchers conducted a systematic review of 46 unique RCTs and identified 4 treatments with potential benefits for GSM symptoms in the short-term: vaginal estrogen, vaginal dehydroepiandrosterone (DHEA), oral ospemifene, and vaginal moisturizers. While none of the treatments were found to improve discomfort or irritation of the vulvar or vaginal area or pain with urination, all 4 may improve dryness of the vulvar or vaginal area. The data did not provide evidence of efficacy or vaginal testosterone, vaginal oxytocin, raloxifene, or bazedoxifene for any GSM symptom.

In a related review, also published in Annals of Internal Medicine, researchers summarized published evidence of using complementary and alternative medicine or therapies (CAMs) as a treatment for those seeking nonhormonal interventions for vulvovaginal, urinary, and sexual symptoms associated with genitourinary syndrome of menopause (GSM). They found large and heterogenous literature that revealed insights into trends in research on CAM interventions for GSM. Researchers studied 57 randomized control trials and employed an evidence map approach to systematically organize and describe the data. They found that most studies were too limited in scope, time, geography, and heterogeneity to allow for evidence synthesis. Notably, limiting trends in study designs include (1) symptom severity not being an inclusion criterion nor often reported, (2) authors infrequently using standard validated measures to assess sexual function, and (3) few studies testing identical products. These limitations make it difficult to compare CAM interventions with broader GSM literature. The authors ground the study in a larger context, remarking that inconsistencies in the natural products and supplements industry are compounded by a lack of regulation. They conclude that more well-designed trials are needed to assist patients and clinicians to make informed decisions about how to best manage patient symptoms.

Media contacts: For an embargoed PDF, please contact Angela Collom at [email protected]. . To speak with authors Elisheva R. Danan, MD, MPH or Kristen Ullman, MPH regarding the reviews, please email Brad Doboszenski at [email protected].