Among the main manifestations of SGUM are dryness of the vulva (decreased lubrication) and vagina, accompanied by itching (pruritus), burning or irritation, and reduced sexual pleasure. These symptoms are often accompanied by pain during penetration (dyspareunia) and post-coital bleeding.
SGUM also includes urinary disorders, including painful or bothersome urination, associated with an intense burning sensation (dysuria), a frequent urge to urinate (pollakiuria), as well as urinary urgency (uncontrolled loss of urine following an urge to sudden and irrepressible urination) but also repeated urinary infections.
Unfortunately, SGUM sets in and gets worse. The proportion of affected patients increases with the years after menopause, exceeding 85% beyond 7 years. For example, 4% of women have vaginal dryness from the start of premenopause, 25% one year after menopause and 47% three years later, according to one study.
Local estrogens can relieve symptoms
To relieve these women, local estrogens can be used for many years or even decades, sometimes at the same time as menopausal hormonal treatment (THM), the latter being prescribed only for a few years, while the related disorders at menopause (hot flashes, sweating, joint pain, etc.) subside.
Local estrogen therapy, also called “local trophic treatment”, is recommended by the National College of French Gynecologists-Obstetricians. It comes in different dosage forms, your choice: in the form of ovules (COLPOTROPHINE®), cream (GYDRELLE®, COLPOTROPHINE®, TROPHICREME®) or a ring with prolonged release over 3 months (ESTRING®, not reimbursed).
The molecules used include estradiol (found in the ring), estriol (in some creams) and promestriene (COLPOTROPHINE®).
This local treatment is beneficial in the context of genitourinary syndrome of menopause, whatever the type used, in the form of cream, ovum or ring, and whether it is estradiol, estriol or prometriene. The recommendations of the National College of Gynecologists-Obstetricians and the GEMVIE group (2021) emphasize the importance of this local treatment, the vaginal route of estrogens having superiority, in particular on urinary symptoms, compared to THM.
Don’t be afraid of local estrogens
However, these local estrogens are too often overlooked because women are unaware of this possibility and many doctors remain reluctant to prescribe hormones. However, studies and recommendations, both national and international, confirm their effectiveness and provide reassurance regarding possible risks.
“I am very reassuring regarding the implementation of this treatment with local estrogens,” indicates Dr Sandrine Campagne-Loiseau, gynecological surgeon (CHU Estaing Clermont-Ferrand) who spoke at the congress of the French Association of Urology ( Paris, November 20-23, 2024). Unlike THM which has specific contraindications for certain patients, local estrogens have no absolute contraindications. However, there are relative contraindications (to be studied on a case-by-case basis, editor’s note), particularly for hormone-dependent cancers. » However, when it comes to endometrial cancer, current data is reassuring. The same goes for women without a history of breast cancer, where studies indicate that long-term local estrogen treatment does not promote breast cancer.
In patients with a history of breast cancer, the studies are also rather reassuring: the 2021 recommendations of the CNGOF – GEMVIE and those emanating from cancer centers are favorable to the use of local estrogens in the event of persistent SGUM symptoms, if non-hormonal methods are insufficient (hyaluronic acid, for example). A large 2023 study of nearly 50,000 women did not find an observed increased risk of breast cancer recurrence within 5 years with the use of vaginal estrogens. “You should not use this treatment during treatment for breast cancer,” specifies the gynecologist, “but when it is at a distance, several years or even decades, there is no contraindication. »
What dosage?
The recommended dosage consists of starting with a daily treatment for several weeks (one egg or one application, or even the installation of a ring), followed by maintenance with one egg or two applications per week.
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Source: Destination Santé
