Vaginal atrophy secondary to menopause can result in genitourinary menopausal syndrome (GUMS), which is particularly bothersome for women. Treatments exist, but they still need to be prescribed. And, beforehand, that the syndrome is diagnosed. In order to combat a certain fatalism among women, secondary to an invisibility of the subject in consultation, it is important to break down the taboo. It is in this sense that, during the Pari(s) Santé Femmes congress (June 12-14, 2024, Paris), Dr. Brigitte Letombe (CHRU Lille) underlined the burden linked to this syndrome and its principles, however simple support.
In the scientific literature, many studies describe the extent of the problem in menopausal women and the lack of treatment: ” SGUM is often underestimated because of the silence of patients and health professionals,” regretted the gynecologist. “During gynecological consultations, it is easy to spot this atrophy. But it is alarming to see that women leave the consultation without the problem being discussed. They think that everything is fine or that there is no solution to their problems. »
The impact of menopause is nevertheless significant: studies that have looked at the subject reveal the frequent existence of sexual problems, from the beginning of menopause. The REVIVE study described among a cohort of women with SGUM that, in half of the cases, this syndrome had never been mentioned by the doctor and that only 40% of women broach the subject themselves. As a result, ” women have lower self-esteem, feel old and less attractive “. This results in repercussions on the marital relationship, with the man avoiding intimacy in 76% of cases.
Local trophic treatment, maintained as long as the syndrome persists
« To avoid SGUM, you need to be sexually active and for sexual activity, you of course need good trophicity “, recalled Brigitte Letombe. Its management is based on local treatment as a first-line treatment with hyaluronic acid or vaginal lubricants and moisturizers. They improve vaginal hydration and elasticity if used regularly. Vaginal estrogens, recognized for their long-term effectiveness, are recommended as a second-line treatment. Local estrogens promote the thickening of the vaginal epithelium, which allows Doderlein’s flora to develop and secondarily reduce the risk of infections. Finally, oral probiotics can be used in conjunction and would reduce the risk of sexually transmitted infections. ” In cases of marked vulvovaginal atrophy, it is recommended to first use lubricants and moisturizers before introducing local estrogens.insisted the gynecologist, “because this limits the systemic passage of hormones favored by atrophy “Other approaches – physical (radiofrequency, biomodulation) or local (hyaluronic acid injection, lipofilling) – are currently being developed and may perhaps join the available arsenal in the coming months or years.
Local estrogens, THMs and breast cancer
There are no contraindications to using local hormonal treatments in addition to systemic treatment. Also, they can be offered in addition to menopausal hormonal treatment (THM) when the latter, prescribed as part of the management of menopause, is insufficient to relieve SGUM. There are many dosage forms (creams, ovules, capsules, rings, etc.) which allow women to choose the one that suits them best.
Local estrogens do not have significant systemic effects and are therefore not associated with an increased risk of cancer or cardiovascular events. They could also be used in women who have had breast cancer, including those treated with anti-aromatases, when non-hormonal local treatments are not indicated or have insufficient efficacy. Current data do not seem to show a risk of breast cancer recurrence, but caution remains necessary.
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