Medications may help vaginal menopause symptoms, but data limited, reviews find

Vaginal estrogen, vaginal dehydroepiandrosterone (DHEA), oral ospemifene, and vaginal moisturizers may improve genitourinary syndrome of menopause in the short term, a systematic review reported.

Researchers compiled data from 46 unique randomized, controlled trials (RCTs) of the four treatments in postmenopausal women with at least one symptom, such as dryness of the vulvar or vaginal area, urgency or pain with urination, pain with intercourse, or decreased libido. Results were published by Annals of Internal Medicine on Sept. 10.

The review found that compared with placebo or no treatment, vaginal estrogen may improve vulvovaginal dryness and dyspareunia as well as whatever symptom patients found most bothersome and overall treatment satisfaction. Compared with placebo, vaginal DHEA may improve dryness, dyspareunia, and distress, bother, or interference from genitourinary symptoms, according to the review, while oral ospemifene may improve dryness, dyspareunia, and treatment satisfaction and vaginal moisturizers may improve dryness. Vaginal testosterone, systemic DHEA, vaginal oxytocin, and oral raloxifene or bazedoxifene may provide no benefit or had uncertain effects, the review found.

Although the studies did not report frequent serious harms, this finding was limited by their duration and power, the study authors wrote.

In a related review, published the same day by Annals, researchers summarized evidence from 57 trials of complementary and alternative medicine or therapies (CAMs) for menopause symptoms. Most studies were too limited in scope, time, geography, and heterogeneity; symptom severity was often not reported; studies infrequently used standard validated measures to assess sexual function; and few studies tested identical products, the review found. These limitations made it difficult to compare interventions, they said.

An editorial commented on the lack of consistency and standardization of studies examining menopause. “These current reports document how stunningly little we know about [genitourinary syndrome of menopause], a condition that affects most postmenopausal women across the globe. Clearly, there is much work to be done to enable definitive conclusions to inform patient care,” the editorialist wrote.