What if you are not a candidate for (local) estrogens?

Abstract

Vulvovaginal atrophy (VVA) or atrophic vaginitis is a clinical challenge because it is underreported by women and underrecognised by healthcare providers (HCPs), and is therefore undertreated. Women are often poorly aware that VVA is a progressive chronic condition with a significant impact on sexual health and quality of life (QoL), but that effective treatments are available. HCPs should be proactive in encouraging women to discuss symptoms related to VVA and to seek treatment. In the REal women's VIews of treatment options for Vaginal changEs (REVIVE) European survey, women who had discussed VVA with an HCP were twice as likely to be current medication users than those who had not (59.7% vs 22.7%, respectively). Local estrogen therapy and over-the-counter products for symptomatic relief have been viewed as the mainstay of treatment for VVA. All types of local estrogen preparations are effective. However, not all women with VVA are candidates for local vaginal estrogen therapy, for example those with contraindications or who are unsuitable for medical or personal reasons (e.g. breast cancer survivors, women with physical inability/impairment or uterine prolapse and those who do not want to use hormones). For these women, it is up to the HCP and the woman to make an appropriate decision regarding treatment. Patient preference is a key factor influencing the choice of treatment for VVA. This may be influenced by the woman's personality type, her personal beliefs, fears and past experiences, and the experiences of family members and friends. It is essential that women are provided with adequate information by well-trained HCPs, and are actively involved in the decision-making process.