Genitourinary syndrome of menopause (GUMS) includes three types of symptoms, related to aging and estrogen deficiency: vulvovaginal (dryness, burning, irritation), sexual (dyspareunia) and urinary (pain when urinating, repeated infections, pollakiuria, nocturia, urgency incontinence). Estimates of its prevalence vary according to studies, the symptoms considered, their severity, and the population studied (from 30 to 70% of women).
THE Latest CNGOF recommendations (2021) recommend, in addition to the essential hygiene and dietary measures (see box), non-hormonal treatments as first-line treatment – vaginal moisturizers (based on hyaluronic acid in particular) and lubricants. In the event of insufficient effect, it is possible to prescribe a low-dose local estrogen treatment (with special precautions for patients who have had breast cancer). The specialties available in France are listed in the tables opposite.
The emergence of other treatments in recent years – non-estrogenic hormonal, systemic therapies – motivated an American team to compare their effectiveness with that of standard treatments. The results of their systemic review have just been published in the journal Annals of Internal Medicine
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She included 46 randomized trials which compared the treatment either to a placebo or to no intervention:
- 22 evaluated a vaginal form of estrogen;
- 16 non-estrogenic hormone treatments (prasterone [DHEA]oxytocin, ospemifene, bazedoxifene, raloxifene, testosterone), local or systemic;
- 4 vaginal moisturizers;
- 4 of multiple interventions.
Most of them lasted 12 weeks maximum. In half of the studies, a moderate to severe intensity of symptoms was an inclusion criterion. Most women were in their 50s (only 2 trials had a mean age > 65 years). Risk factors for cardiovascular disease, cancer, or venous thromboembolism were exclusion criteria (except in 4 trials that enrolled patients with current or cured cancer).
Heterogeneity between studies (populations included, diagnostic criteria of the SGUM, interventions, comparators, outcome measures, etc.) prevented the performance of a meta-analysis of their results.
