Key takeaways:
- Genitourinary syndrome of menopause is frequent however typically underrecognized in dermatology.
- Low-dose vaginal estrogen is secure and efficient for treating vaginal atrophy signs, together with itch.
Dermatologists are nicely positioned to deal with vulvovaginal problems frequent amongst menopausal ladies, together with itch, but sufferers are sometimes hesitant to explain signs and clinicians could also be unaware of the best therapy choices.
Genitourinary syndrome of menopause (GSM), previously generally known as vulvovaginal atrophy, impacts as much as 84% of postmenopausal ladies with signs together with dryness, burning, itching, dyspareunia and recurrent urinary tract infections. These signs can worsen and influence high quality of life when left untreated, but sufferers are sometimes hesitant to provoke a dialog with their doctor, in accordance with Shoshana Marmon, MD, PhD, FAAD, assistant professor within the division of dermatology at New York Medical Faculty. Dermatologic literature highlights energy-based applied sciences to deal with GSM, reminiscent of laser and radiofrequency gadgets, which aren’t FDA permitted for this indication and have low-quality proof supporting their use. First-line therapies for GSM, reminiscent of vaginal moisturizers and lubricants, are sometimes ineffective for girls with extra reasonable to extreme signs, Marmon stated.
Healio spoke with Marmon, who additionally chairs the American Academy of Dermatology’s Menopause and Ladies’s Well being in Dermatology High quality Enchancment Workgroup, concerning the position dermatologists ought to play in recognizing, diagnosing and treating GSM; efficient obtainable therapies; and why clinicians and sufferers ought to suppose in another way about low-dose vaginal estrogens. The workgroup’s suggestions had been not too long ago revealed within the Journal of the American Academy of Dermatology.
Healio: How are dermatologists uniquely positioned to acknowledge and diagnose vulvovaginal problems in menopausal sufferers?
Marmon: Dermatologists continuously handle persistent vulvar circumstances like lichen sclerosis, lichen planus and lichen simplex chronicus. These typically current with itching, burning, ache or fissuring — signs that overlap with GSM. That is an space the place we’re comfy managing, understanding what’s regular and what’s not. That is our core demographic. If a middle-aged girl is available in reporting hair loss, it isn’t unusual to ask if they’re additionally experiencing vaginal dryness. Ladies might really feel uncomfortable bringing these signs up. The one factor lacking is the attention and ubiquity of this prognosis. There may be additionally quite a lot of misinformation on-line and dietary supplements marketed that might not be proof primarily based. As a result of we routinely look at vulvovaginal pores and skin and are educated in mucocutaneous illness, dermatologists are in a novel place to acknowledge GSM early and precisely.
Healio: What are the therapy choices for girls with GSM?
Marmon: First-line choices embody vaginal moisturizers and lubricants. For some ladies with gentle signs, this can be all they want. For others, these typically present solely non permanent aid.
For persistent or moderate-to-severe signs, low-dose vaginal estrogen is the gold-standard therapy. It’s obtainable in a number of varieties, together with lotions, tablets, rings and inserts. These formulations are secure, efficient and supported by a long time of scientific analysis. Nonestrogen therapies like vaginal dehydroepiandrosterone and oral ospemifene are additionally obtainable.
Healio: What ought to dermatologists consider when prescribing vaginal estrogens?
Marmon: Vaginal estrogen may be very nicely studied, and when used at low doses as directed to the vulvovaginal space, leads to minimal systemic absorption. Nonetheless, hesitation persists amongst sufferers and physicians because of the FDA’s black field warning, which fails to distinguish between systemic and native hormone therapies. There are physician-driven efforts and advocacy group efforts to alter or take away the black field warning. The issue is we’d like randomized managed trial information, that are what FDA needs. The warning is way stronger than it must be; it doesn’t distinguish between systemic and low-dose vaginal estrogen.
A 2024 meta-analysis of vaginal estrogen use in breast most cancers survivors discovered no elevated danger for recurrence, breast cancer-specific mortality or general mortality. These information reinforce its security, even on this high-risk inhabitants. Dermatologists ought to really feel assured recommending vaginal estrogen when clinically applicable and may educate sufferers about its security. Coordination with gynecology or oncology is beneficial in sure instances and beneficial for sufferers with a historical past of hormone-sensitive most cancers. We wish folks to get comfy with prescribing these drugs.
Healio: What are the important thing take-home messages out of your paper?
Marmon: Menopause is a common course of, but most clinicians haven’t obtained enough coaching on this space. GSM is frequent, underrecognized and infrequently presents with signs acquainted to dermatologists. We’re treating comparable circumstances with comparable signs within the vaginal space. There isn’t a motive to not deal with this, too. That pruritus in a 50-year-old girl might be a part of the vaginal atrophy seen in GSM. Our AAD-endorsed article urges dermatologists to take a extra energetic position in diagnosing and treating GSM, particularly since we already handle many overlapping vulvar circumstances. Most significantly, we emphasize that low-dose vaginal estrogen is a secure, efficient and evidence-based therapy that must be extra routinely thought of in dermatologic care of menopausal sufferers.
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For extra info:
Shoshana Marmon, MD, PhD, FAAD, will be reached at Shoshana.marmon@nychhc.org.
