Hormonal Treatments and Vaginal Moisturizers for Genitourinary Syndrome of Menopause : A Systematic Review.

Autor:	Danan ER; Center for Care Delivery & Outcomes Research, VA Health Care System, and Department of Medicine, University of Minnesota, Minneapolis, Minnesota (E.R.D., S.D.)., Sowerby C; Center for Care Delivery & Outcomes Research, VA Health Care System, Minneapolis, Minnesota (C.S., K.E.U., N.Z., M.A., C.K., A.L., N.G.)., Ullman KE; Center for Care Delivery & Outcomes Research, VA Health Care System, Minneapolis, Minnesota (C.S., K.E.U., N.Z., M.A., C.K., A.L., N.G.)., Ensrud K; Center for Care Delivery & Outcomes Research, VA Health Care System; Department of Medicine, University of Minnesota; and Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota (K.E.)., Forte ML; Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota (M.L.F., H.I.A., M.B.)., Zerzan N; Center for Care Delivery & Outcomes Research, VA Health Care System, Minneapolis, Minnesota (C.S., K.E.U., N.Z., M.A., C.K., A.L., N.G.)., Anthony M; Center for Care Delivery & Outcomes Research, VA Health Care System, Minneapolis, Minnesota (C.S., K.E.U., N.Z., M.A., C.K., A.L., N.G.)., Kalinowski C; Center for Care Delivery & Outcomes Research, VA Health Care System, Minneapolis, Minnesota (C.S., K.E.U., N.Z., M.A., C.K., A.L., N.G.)., Abdi HI; Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota (M.L.F., H.I.A., M.B.)., Friedman JK; VA Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, California (J.K.F.)., Landsteiner A; Center for Care Delivery & Outcomes Research, VA Health Care System, Minneapolis, Minnesota (C.S., K.E.U., N.Z., M.A., C.K., A.L., N.G.)., Greer N; Center for Care Delivery & Outcomes Research, VA Health Care System, Minneapolis, Minnesota (C.S., K.E.U., N.Z., M.A., C.K., A.L., N.G.)., Nardos R; Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, Minnesota (R.N.)., Fok C; Department of Urology, University of Minnesota, Minneapolis, Minnesota (C.F.)., Dahm P; Urology Section, VA Health Care System, and Department of Urology, University of Minnesota, Minneapolis, Minnesota (P.D.)., Butler M; Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota (M.L.F., H.I.A., M.B.)., Wilt TJ; Center for Care Delivery & Outcomes Research, VA Health Care System; Department of Medicine, University of Minnesota; and Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota (T.J.W.)., Diem S; Center for Care Delivery & Outcomes Research, VA Health Care System, and Department of Medicine, University of Minnesota, Minneapolis, Minnesota (E.R.D., S.D.).
Jazyk:	angličtina
Zdroj:	Annals of internal medicine [Ann Intern Med] 2024 Oct; Vol. 177 (10), pp. 1400-1414. Date of Electronic Publication: 2024 Sep 10.
DOI:	10.7326/ANNALS-24-00610
Abstrakt:	Background: Postmenopausal women commonly experience vulvovaginal, urinary, and sexual symptoms associated with genitourinary syndrome of menopause (GSM). Purpose: To evaluate effectiveness and harms of vaginal estrogen, nonestrogen hormone therapies, and vaginal moisturizers for treatment of GSM symptoms. Data Sources: Medline, Embase, and CINAHL through 11 December 2023. Study Selection: Randomized controlled trials (RCTs) of at least 8 weeks' duration enrolling postmenopausal women with at least 1 GSM symptom and reporting effectiveness or harms of hormonal interventions or vaginal moisturizers. Data Extraction: Risk of bias and data extraction were performed by one reviewer and verified by a second reviewer. Certainty of evidence (COE) was assessed by one reviewer and verified by consensus. Data Synthesis: From 11 993 citations, 46 RCTs evaluating vaginal estrogen ( k = 22), nonestrogen hormones ( k = 16), vaginal moisturizers ( k = 4), or multiple interventions ( k = 4) were identified. Variation in populations, interventions, comparators, and outcomes precluded meta-analysis. Compared with placebo or no treatment, vaginal estrogen may improve vulvovaginal dryness, dyspareunia, most bothersome symptom, and treatment satisfaction. Compared with placebo, vaginal dehydroepiandrosterone (DHEA) may improve dryness, dyspareunia, and distress, bother, or interference from genitourinary symptoms; oral ospemifene may improve dryness, dyspareunia, and treatment satisfaction; and vaginal moisturizers may improve dryness (all low COE). Vaginal testosterone, systemic DHEA, vaginal oxytocin, and oral raloxifene or bazedoxifene may provide no benefit (low COE) or had uncertain effects (very low COE). Although studies did not report frequent serious harms, reporting was limited by short-duration studies that were insufficiently powered to evaluate infrequent serious harms. Limitations: Most studies were 12 weeks or less in duration and used heterogeneous GSM diagnostic criteria and outcome measures. Few studies enrolled women with a history of cancer. Conclusion: Vaginal estrogen, vaginal DHEA, oral ospemifene, and vaginal moisturizers may improve some GSM symptoms in the short term. Few long-term data exist on efficacy, comparative effectiveness, tolerability, and safety of GSM treatments. Primary Funding Source: Agency for Healthcare Research and Quality and Patient-Centered Outcomes Research Institute. (PROSPERO: CRD42023400684). Competing Interests: Disclosures: All relevant financial relationships have been mitigated. Disclosure forms are available with the article online.
Databáze:	MEDLINE
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