-
The Journals of Gerontology. Series A,... Aug 2021The genitourinary syndrome of menopause (GSM) describes signs and symptoms resulting from effects of estrogen deficiency on the female genitourinary tract, including the...
The genitourinary syndrome of menopause (GSM) describes signs and symptoms resulting from effects of estrogen deficiency on the female genitourinary tract, including the vagina, labia, urethra, and bladder. Signs/symptoms associated with GSM may occur during any reproductive stage from multiple etiologies but are most common during menopause due to low estrogen. Vaginal microbiota, particularly Lactobacillus spp., are beneficial to the female genital tract; however, their abundance declines during menopause. We aimed to longitudinally assess vaginal microbiota characterized by 16S rRNA gene amplicon sequencing and GSM-associated endpoints across reproductive stages. In a 2-year cohort study of 750 women aged 35-60 years at enrollment and 2 111 semiannual person-visits, low-Lactobacillus vaginal microbiota communities were observed at 21.2% (169/798), 22.9% (137/597), and 49.7% (356/716) of person-visits among pre-, peri-, and postmenopausal women, respectively (p < .001). Compared to communities that have high Gardnerella vaginalis relative abundance and diverse anaerobes, the following communities were associated with a lower covariate-adjusted odds of vaginal atrophy: L crispatus-dominated communities among postmenopausal women (odds ratio [OR] = 0.25; 95% confidence interval [CI]: 0.08, 0.81), L gasseri/L jensenii (OR = 0.21; 95% CI: 0.05, 0.94) and L iners (OR = 0.21; 95% CI: 0.05, 0.85) among perimenopausal women, and L iners-dominated communities (OR = 0.18; 95% CI: 0.04, 0.76) among premenopausal women. Postmenopausal women with L gasseri/L jensenii-dominated communities had the lowest odds of vaginal dryness (OR = 0.36; 95% CI: 0.12, 1.06) and low libido (OR = 0.28; 95% CI: 0.10, 0.74). Findings for urinary incontinence were inconsistent. Associations of vaginal microbiota with GSM signs/symptoms are most evident after menopause, suggesting an avenue for treatment and prevention.
Topics: Adult; Atrophy; Dyspareunia; Female; Female Urogenital Diseases; Gardnerella vaginalis; Humans; Lactobacillus; Menopause; Microbiota; Middle Aged; Syndrome; Vagina; Vaginal Diseases; Vulvar Diseases
PubMed: 33903897
DOI: 10.1093/gerona/glab120 -
BMC Women's Health Dec 2022Genitourinary syndrome of menopause (GSM) comprises genital symptoms (dryness, burning, itching, irritation, bleeding), sexual symptoms (dyspareunia and other sexual... (Review)
Review
Investigation on prevalence and risk factors associated with genitourinary syndrome of menopause in middle-aged and older women in Beijing community: a cross sectional study.
BACKGROUND
Genitourinary syndrome of menopause (GSM) comprises genital symptoms (dryness, burning, itching, irritation, bleeding), sexual symptoms (dyspareunia and other sexual dysfunctions) and urinary symptoms (dysuria, frequency, urgency, recurrent urinary infections) associated with menopause. To avoid invasive testing and painful physical examinations, validated questionaries, which can assess the prevalence and risk factors associated with symptoms of GSM. We aimed to investigate the prevalence and risk factors associated with GSM in middle-aged and older women in the communities of Beijing, China.
METHODS
A cross-sectional, questionnaire study was performed among 35-70 years old Chinese woman. Vaginal health index score and urinary distress inventory (UDI-6) was used to evaluate vulvovaginal atrophy (VVA) and urinary incontinence (UI). Stages of pelvic organ prolapse (POP) was measured during gynecological examination with POP-Q system. Mean ± standard deviation (SD) and proportion/percentages were used to summarize continuous and categorial variables respectively. The Bonferroni method was used to adjust for multiple comparisons.
RESULTS
A total of 2702/3000 participants completed the questionnaire survey. The mean ± SD age of participants was 53.7 ± 7.0 years and prevalence of VVA among participants was 34.8% (941/2702). In UDI-6 questionnaires total 47.5% (1284/2702) participants reported experiencing urinary incontinence (UI). Further, POP was highly prevalent in anterior vaginal wall 38.9% (1050/2702) followed by posterior vaginal wall 25.3% (683/2702) and uterine 22.2% (599/2702). Besides, multiple logistic regression analysis inferred older age (45-54 years [OR (95% CI): 3.38 (2.03, 5.64)]; 55-64 years [OR (95% CI): 8.63 (5.09, 14.64)]), menopause [OR (95% CI): 2.20 (1.71, 2.85)] and Faecal Inconsistence (FI) [OR (95% CI): 1.31(1.00, 1.72)] as independent risk factors for VVA.
CONCLUSIONS
Our study evidenced that GSM is prevalent in old age Chinese women. GSM is related with UI, POP and VVA. Further older age, menopause and FI were risk factors associated with VVA. Our findings could help health care personnel to get a comprehensive overview of factors associated with VVA and urinal distress, which may facilitate early detection and prevention of GSM.
Topics: Middle Aged; Female; Humans; Aged; Adult; Cross-Sectional Studies; Beijing; Prevalence; Menopause; Vagina; Urinary Incontinence; Risk Factors; Atrophy; Vaginal Diseases
PubMed: 36585649
DOI: 10.1186/s12905-022-02099-w -
Investigative and Clinical Urology Mar 2023This study aimed to develop hyaluronic acid (HA)-based, retinoic acid (RA)-containing nanomicelles and to investigate the effects of these newly developed nanomicelles...
PURPOSE
This study aimed to develop hyaluronic acid (HA)-based, retinoic acid (RA)-containing nanomicelles and to investigate the effects of these newly developed nanomicelles on regeneration of the vaginal epithelium and aquaporin 3 (AQP3) expression in a murine menopause model.
MATERIALS AND METHODS
The HA-based, RA-loaded nanomicelles were developed, and the RA-loading rate, encapsulation efficiency, and hydrodynamic diameter were measured. Female BALB/c mice (8 weeks; n=30) were divided into control and experimental groups. Menopause was established in the experimental group by removing both ovaries. The experimental group was further divided into an ovariectomy group, an HA-C18 vehicle group, and an HA-C18-RA group (2.5 µg per mouse); vaginal administration of HA-C18 or HA-C18-RA was performed once daily. After 4 weeks of treatment, murine vaginal tissue was removed, and histological analysis was performed.
RESULTS
Three drug-loaded nanomicelles were synthesized: the RA content in HA-C18-RA-10, HA-C18-RA-20, and HA-C18-RA-30 was 3.13%, 2.52%, and 16.67%, respectively, and the RA encapsulation efficiency was 95.57%, 83.92%, and 93.24%, respectively. In the experimental versus control group, serum estrogen levels were significantly reduced, and the vaginal mucosal epithelial layer was significantly thinner. After 4 weeks of treatment, the thickness of the vaginal mucosal epithelial layer and AQP3 expression was increased in the HA-C18-RA group compared with the HA-C18 vehicle group.
CONCLUSIONS
The newly developed HA-based nanomicelles containing RA resulted in vaginal epithelial recovery and increased AQP3 expression. The results may contribute to the development of functional vaginal lubricants or moisturizers for the treatment of vaginal dryness.
Topics: Female; Animals; Mice; Retinoids; Hyaluronic Acid; Tretinoin; Epithelium; Menopause; Mice, Inbred BALB C
PubMed: 36882178
DOI: 10.4111/icu.20220366 -
Asia-Pacific Journal of Oncology Nursing 2021Physiological and/or psychological problems that affect the quality of life of the patients occur depending on the diagnosis and treatment of hematological malignancies....
OBJECTIVE
Physiological and/or psychological problems that affect the quality of life of the patients occur depending on the diagnosis and treatment of hematological malignancies. Cancer treatment causes sexual problems such as infertility, vaginal dryness, and erectile dysfunction in the patients. Erectile dysfunction and loss of sexual desire are the most common sexual problems of men, while dyspareunia and loss of sexual desire are the most common sexual problems of women. This descriptive study was carried out to evaluate sexual problems and affecting factors in the patients with hematological cancer.
METHODS
Between July 1, 2011, and July 31, 2011, 45 sexually active patients who volunteered to participate in the study and whose written consents were obtained were included in the study. The data of the study were collected using the descriptive characteristics form prepared by the researchers based on the relevant literature and the Arizona Sexual Experiences Scale (ASEX). The scale scores range from 5 to 30 and a score of >11 above indicates sexual dysfunction.
RESULTS
Sexual dysfunction was observed in 62.2% of the patients. About 80.0% of women and 57.1% of men had sexual dysfunction. Sexual dysfunction was observed to be highest between the ages of 52-71 (81.2%) years. The mean total ASEX score was 15.90 ± 4.25 in women and 13.34 ± 5.37 in men. The ability to reach orgasm subscale score was found to differ by gender in the ASEX scale ( < 0.05).
CONCLUSIONS
The prevalence of sexual dysfunction is high in the patients with hematological malignancies. It is recommended to evaluate these patients in terms of the presence of sexual dysfunction, as in the patients with other chronic diseases.
PubMed: 33426190
DOI: 10.4103/apjon.apjon_40_20 -
BMC Cancer Nov 2023Vaginal CO laser therapy is a new treatment option for genitourinary syndrome of menopause. Its potential is particularly interesting in breast cancer survivors, where...
BACKGROUND
Vaginal CO laser therapy is a new treatment option for genitourinary syndrome of menopause. Its potential is particularly interesting in breast cancer survivors, where existing treatment options often are insufficient as hormonal treatment is problematic in these women. The objective of this study is to investigate the effectiveness of vaginal laser treatment for alleviation of genitourinary syndrome of menopause in breast cancer survivors treated with adjuvant endocrine therapy. The secondary objective is to explore the importance of repeated vaginal laser treatment and the long-term effects in this patient population.
METHODS
VagLaser consist of three sub-studies; a dose response study, a randomized, participant blinded, placebo-controlled study and a follow-up study. All studies include breast cancer survivors in adjuvant endocrine therapy, and are conducted at the Department of Obstetrics and Gynecology, Randers Regional Hospital, Denmark. The first participant was recruited on 16th of February 2023. Primary outcome is vaginal dryness. Secondary subjective outcomes are vaginal pain, itching, soreness, urinary symptoms and sexual function. Secondary objective outcomes are change in vaginal histology (punch biopsy), change in vaginal and urine microbiota, and change in vaginal pH.
DISCUSSION
More randomized controlled trials, with longer follow-up to explore the optimal treatment regimen and the number of repeat vaginal laser treatments for alleviation the symptoms of genitourinary syndrome of menopause in breast cancer survivors treated with endocrine adjuvant therapy, are needed. This study will be the first to investigate change in vaginal and urine microbiota during vaginal laser therapy in breast cancer survivors.
TRIAL REGISTRATION
ClinicalTrials.gov: NCT06007027 (registered 22 August, 2023).
PROTOCOL VERSION
Version 1, Date 13.11.2023.
Topics: Humans; Female; Breast Neoplasms; Cancer Survivors; Carbon Dioxide; Follow-Up Studies; Laser Therapy; Female Urogenital Diseases; Menopause; Vagina; Urogenital Neoplasms; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 38031020
DOI: 10.1186/s12885-023-11656-x -
Annals of Medicine Dec 2021In puerperium, the hypoestrogenic state induced by delivery and subsequently sustained by lactation may lead to vaginal dryness, burning, and itching sensation,... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
In puerperium, the hypoestrogenic state induced by delivery and subsequently sustained by lactation may lead to vaginal dryness, burning, and itching sensation, contributing to the onset of sexual dysfunction.
MATERIAL AND METHODS
This was a prospective, randomized, controlled, open-label study (NCT04560283) for evaluating the effects of application of a prolonged-release hyaluronic acid derivative vaginal gel in restoring sexual function during the postpartum period. Eighty-five patients were randomized to apply prolonged-release Hydeal-D 0.2% vaginal gel (Fidia Farmaceutici, Abano Terme, Italy; = 43) every three days for 12 consecutive weeks or expectant management ( = 42).
RESULTS
Women undergoing treatment had a more elevate increase in Female Sexual Function Index (FSFI) total score (+15.1 ± 11.9 vs +6.5 ± 8.9, < 0.001) and a higher decrease in vaginal pH (-1.2 ± 0.7 vs -0.2 ± 1.1; < 0.001). Moreover, the proportion of vaginal smears with maturation index (VMI) >65 was significantly higher in patients treated (80.6% vs 35.3%; = 0.004). Edinburgh Postnatal Depression Scale (EPDS) decreased significantly in both groups with no inter-group difference ( = 0.459). Only two cases (4.8%) of moderate vaginal burning sensation were reported in patients undergoing local vaginal therapy.
CONCLUSIONS
The results of our study demonstrated that hyaluronic acid derivative vaginal gel (Hydeal-D) was able to improve sexual function of puerperal women in the short-term treatment.KEY MESSAGEIn the puerperium, the hypoestrogenic state induced by delivery and subsequently sustained by lactation may lead to vaginal dryness, burning, and itching sensation, contributing to the onset of sexual dysfunction.Hydeal-D is a prolonged-release hyaluronic acid derivative characterised by elevated resistance to enzymatic breakdown. During puerperium, its local application may improve the vaginal microenvironment by ensuring a better migration and proliferation of cells involved in local tissue repair.Among puerperal women, Hydeal-D vaginal gel causes a significant improvement of sexual function, including desire, arousal, and lubrification, compared to expectant management. Furthermore, it leads to a decrease in vaginal pH and an increase of the trophic status of vaginal epithelium.
Topics: Adult; Depression, Postpartum; Female; Humans; Hyaluronic Acid; Italy; Postpartum Period; Prospective Studies; Pruritus; Sexual Dysfunction, Physiological; Vaginal Creams, Foams, and Jellies; Vaginal Diseases
PubMed: 34477473
DOI: 10.1080/07853890.2021.1974083 -
Breast Cancer Research and Treatment Oct 2023To analyze serum estradiol (E2) and estrone (E1) during letrozole treatment and their association to Quality of Life (QoL) and side-effects. (Clinical Trial)
Clinical Trial
Effects of letrozole on serum estradiol and estrone in postmenopausal breast cancer patients and tolerability of treatment: a prospective trial using a highly sensitive LC-MS/MS (liquid chromatography-tandem mass spectrometry) method for estrogen measurement.
PURPOSE
To analyze serum estradiol (E2) and estrone (E1) during letrozole treatment and their association to Quality of Life (QoL) and side-effects.
METHODS
Postmenopausal breast cancer patients starting adjuvant letrozole were eligible. Serum samples were taken at baseline, three, and 12 months. E2 and FSH were measured with routine chemiluminescent immunoassays. E2 and E1 were analyzed after trial completion with a highly sensitive liquid chromatography-tandem mass spectrometry method (LC-MS/MS) with lower limits of quantification (LLOQ) of 5 pmol/L. QoL was measured at baseline and at 12 months with the EORTC QLQ-C30 and QLQ-BR23 and the Women's Health questionnaires, and menopause-related symptoms with the modified Kupperman Index.
RESULTS
Of 100 screened patients 90 completed the trial. Baseline mean LC-MS/MS E2 and E1 were 12 pmol/L (range < 5-57) and 66 pmol/L (< 5-226), respectively. E2 levels measured by immunoassay and LC-MS/MS showed no correlation. E2 and E1 were completely suppressed by letrozole except for one occasion (E1 11 pmol/L at 3 months). Pain, side effects of systemic therapy, vasomotor symptoms, joint and muscle aches, and vaginal dryness increased during letrozole treatment. A high baseline E2 was significantly associated with increased aching joints and muscles, but not with the other side effects.
CONCLUSIONS
Letrozole supresses E2 and E1 completely below the LLOQ of the LC-MS/MS in postmenopausal women. High pre-treatment E2 levels were associated with more joint and muscle pain during letrozole. Automated immunoassays are unsuitable for E2 monitoring during letrozole therapy due to poor sensitivity.
Topics: Female; Humans; Breast Neoplasms; Chromatography, Liquid; Estradiol; Estrogens; Estrone; Letrozole; Postmenopause; Prospective Studies; Quality of Life; Tandem Mass Spectrometry
PubMed: 37491651
DOI: 10.1007/s10549-023-07054-3 -
Maturitas Aug 2022To evaluate whether single measurements of serum estradiol (E), estrone (E) and sex hormone-binding globulin (SHBG) concentration distinguishes between women with and... (Clinical Trial)
Clinical Trial
OBJECTIVES
To evaluate whether single measurements of serum estradiol (E), estrone (E) and sex hormone-binding globulin (SHBG) concentration distinguishes between women with and without menopausal symptom bother.
STUDY DESIGN
We analyzed baseline data from two clinical trials conducted in 2012-2017: MsFLASH 03 (178 peri-/post-menopausal women aged 40-62 years with bothersome vasomotor symptoms, mean age 54) and MsFLASH 05 (181 post-menopausal women aged 45-70 years with moderate-to-severe vulvovaginal symptoms, mean age 61).
MAIN OUTCOME MEASURES
Symptom bother (hot flushes or flashes, night sweats, sweating, aching in muscles and joints, change in sexual desire, vaginal dryness during intercourse, and avoiding intimacy) in the past month was assessed using the Menopause-Specific Quality of Life questionnaire. Using logistic regression, we calculated the area under the receiver operating characteristic curve (AUC) values for E, E, and SHBG concentration in relation to being at least somewhat bothered (symptom bother score ≥3) by each symptom within each trial study population.
RESULTS
AUC values (95% confidence interval) ranged between 0.51 (0.41-0.60) and 0.62 (0.53, 0.72) for MsFLASH 03 and between 0.51 (0.42, 0.59) and 0.64 (0.53, 0.75) for MsFLASH 05. There was little evidence of associations between serum hormone levels and bother by a given menopausal symptom.
CONCLUSION
These findings do not support the clinical utility of a single measurement of serum of E, E, or SHBG concentrations in differentiating between women who are bothered by a given menopausal symptom and those who are not.
Topics: Aged; Estrogens; Female; Hot Flashes; Humans; Menopause; Postmenopause; Quality of Life; Sweating
PubMed: 35489132
DOI: 10.1016/j.maturitas.2022.04.003 -
Ginekologia Polska Sep 2021The aim of the study was to evaluate the effectiveness of CO₂ fractional laser therapy on perimenopausal urogenital symptoms.
OBJECTIVES
The aim of the study was to evaluate the effectiveness of CO₂ fractional laser therapy on perimenopausal urogenital symptoms.
MATERIAL AND METHODS
This prospective, open-label study included 205 patients who received three CO₂ laser treatments. Clinical assessment was checked at baseline as well as at six weeks and 12 months post-treatment. The following scores were measured Vaginal Health Index Score (VHIS), International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and assessment of the severity of selected urogenital symptoms.
RESULTS
Significant improvements in dryness, dyspareunia, burning, vaginal laxity, urinary incontinence, as were the results on the VHIS and ICIQ-UI SF at six weeks post-treatment (p < 0.05 for all scores), which were maintained through the follow-up visit at 12 months. No complications were observed either during or after laser therapy.
CONCLUSIONS
CO₂ ablative laser treatment can be effective in reducing vulvovaginal atrophy symptoms such as vaginal laxity, dryness, painful sexual intercourse, burning, and decreases the severity of stress urinary incontinence and urge incontinence symptoms. Positive results were maintained at 12 months after the laser treatment.
PubMed: 34541642
DOI: 10.5603/GP.a2021.0140 -
Nutrients Aug 2023There is a longstanding interest in the relationship between diet and hot flash symptoms during midlife, especially in whether phytoestrogens ease menopausal symptoms....
There is a longstanding interest in the relationship between diet and hot flash symptoms during midlife, especially in whether phytoestrogens ease menopausal symptoms. The purpose of this study was to examine hot flashes, night sweats, trouble sleeping, and vaginal dryness in relation to the intake of foods rich in phytoestrogens among Bangladeshi women aged 35 to 59 years who were living either in Sylhet, Bangladesh ( = 157) or as migrants in London ( = 174). Consumption ranges for phytoestrogens were constructed from food frequencies. We hypothesized that diets rich in isoflavones, lignans, and coumestrol would be associated with lower symptom frequencies. However, adjusted logistic regression results showed that with each incremental increase in general phytoestrogen consumption (scale of 0 to 10), the likelihood of hot flashes increased by 1.4%. Each incremental increase in lignan consumption raised the likelihood of hot flashes by 1.6%. In contrast, the odds of vaginal dryness decreased by 2%, with each incremental increase in phytoestrogen and lignan consumption, and by 4%, with each incremental increase in isoflavone consumption. Night sweats and trouble sleeping were not associated with phytoestrogen intake in logistic regressions. Our findings add to the conflicting data on relationships between phytoestrogens and symptoms associated with menopause.
Topics: Humans; Female; Phytoestrogens; Bangladesh; London; Hot Flashes; Isoflavones; Lignans
PubMed: 37686708
DOI: 10.3390/nu15173676