Treatment
14
Treatment of Genitourinary Syndrome of Menopause
Vaginal Moisturizers and Lubricants
Î For postmenopausal women with symptoms of vulvovaginal
atrophy (VVA), ES suggests a trial of vaginal moisturizers to be
used at least twice weekly. (2|⊕⊕
)
Î For women who do not produce sufficient vaginal secretions
for comfortable sexual activity, ES suggests vaginal lubricants.
(2|⊕⊕
)
Vaginal Estrogen Therapies
Î For women without a history of hormone- (estrogen) dependent
cancers who are seeking relief from symptoms of genitourinary
syndrome of menopause (GSM) (including VVA) that persist
despite using vaginal lubricants and moisturizers, ES recommends
low-dose vaginal ET. (1|⊕⊕⊕
)
Î In women who present with symptomatic GSM (including
VVA) with a history of breast or endometrial cancer that does
not respond to nonhormonal therapies, ES suggests a shared
decision-making approach that includes the treating oncologist to
discuss using low-dose vaginal ET. (US)
Î For women taking raloxifene, without a history of hormone-
(estrogen) dependent cancers, who develop symptoms of GSM
(including VVA) that do not respond to nonhormonal therapies, ES
suggests adding low-dose vaginal ET. (2|⊕⊕
)
Î For women using low-dose vaginal ET, ES suggests against adding
a progestogen (ie, no need for adding progestogen to prevent
endometrial hyperplasia). (2|⊕
)
Î For women using vaginal ET who report postmenopausal bleeding
or spotting, ES recommends prompt evaluation for endometrial
pathology. (1|⊕⊕
)
