New Position Statement on Genitourinary syndrome released by NAMS

Written By :  Dr. Kamal Kant Kohli
Published On 2020-09-11 12:30 GMT   |   Update On 2020-09-12 09:18 GMT
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CLEVELAND, Ohio --The North American Menopause Society (NAMS) has announced publication of its 2020 Genitourinary Syndrome of Menopause (GSM) Position Statement. The position statement is available online and will be published in the latest issue of Menopause, the journal of NAMS.

The new recommendations reflect the healthcare community's most recent and proven safe and effective therapies for treating women with GSM, including intravaginal dehydroepiandrosterone (DHEA), oral ospemifene, and a low-dose estradiol vaginal insert.

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Genitourinary syndrome of menopause affects approximately 27% to 84% of postmenopausal women and can significantly impair health, sexual function, and quality of life. Unfortunately, it remains underdiagnosed and undertreated, leaving many women to suffer silently. The most commonly reported symptoms include irritation of the vulva, inadequate vaginal lubrication, burning, dysuria, dyspareunia, and vaginal discharge.

In developing the new position statement, NAMS reviewed current data on a wide variety of proposed treatments to determine their efficacy and safety before making recommendations. According to the 2020 position statement, first-line therapies for less-severe symptoms include nonhormone vulvar and vaginal lubricants with sexual activity and long-acting vaginal moisturizers used regularly. Prescription therapies include low-dose vaginal estrogens, vaginal DHEA inserts, and oral ospemifene. For women with moderate to severe dyspareunia associated with GSM and with concurrent vasomotor symptoms, transdermal and oral hormone therapy are effective options.

MAIN RECOMMENDATIONS-
-Education about and screening for GSM is recommended for perimenopausal and postmenopausal women. [Level C]
-First-line therapies for women with GSM include non-hormone lubricants with sexual activity and regular use of long-acting vaginal moisturizers. [Level A]
-For women with moderate to severe GSM and those who do not respond to lubricants and moisturizers, several safe and effective options are available:
– Low-dose vaginal ET [Level A]
– Vaginal DHEA [Level A]
– Ospemifene [Level A]
– Systemic ET (when VMS are also present) [Level A]
-For women with a history of breast or endometrial cancer, management depends on a woman's preferences, symptom severity, and understanding of potential risks after consultation with her oncologist. [Level C]
-Although product labeling for low-dose vaginal ET notes risks associated with systemic HT (including CHD, stroke, VTE,breast and endometrial cancer), these risks are highly unlikely given minimal systemic absorption and reassuring findings from clinical trials and observational studies. [Level B]
-Use of a progestogen is not recommended with low-dose vaginal ET, although women at increased risk of endome-trial cancer may warrant endometrial surveillance. Endo-metrial safety clinical trial data are not available for use
longer than 1 year, although observational studies are reassuring regarding longer-term use. [Level B]
-Routine endometrial surveillance is not recommended for asymptomatic women using low dose vaginal ET. Trans-vaginal ultrasound or intermittent progestogen therapy may
be considered for women at increased risk of endometrial cancer. [Level C]
-Spotting or bleeding in a postmenopausal woman requires a thorough evaluation that may include TVU and/or endo-metrial biopsy. [Level A]
-Energy-based therapies, including vaginal laser and radio-frequency devices, require long-term, sham-controlled safety and efficacy studies before their routine use can be recommended. [Level C]
-Therapy for GSM should be continued, with appropriate clinical follow up, for as long as bothersome symptoms are present. [Level C]

The position statement additionally points out that long-term studies on the endometrial safety of vaginal estrogen, vaginal DHEA, and ospemifene are lacking. In addition, NAMS believes there are insufficient placebo-controlled trials of energy-based therapies, including laser, to draw conclusions on their efficacy and safety or to make treatment recommendations for those devices.

"Since our last position statement on this topic published in 2013, there have been important additions in terms of safe and effective therapeutic options for women with GSM," says Dr. Stephanie S. Faubion, NAMS Medical Director and member of the Editorial Panel of the Position Statement. "NAMS has reviewed existing data on these therapies as well as on emerging treatment modalities such as energy devices. What hasn't changed is that GSM remains underdiagnosed and undertreated and continues to be a significant quality-of-life issue for women. NAMS endorses educating about and screening for GSM in all perimenopausal and postmenopausal women."

The new position statement can be found online at https://www.menopause.org/docs/default-source/default-document-library/2020-gsm-ps.pdf.



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Article Source : North American Menopause Society

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