Vaginal Estrogen Use Research Articles

The use of vaginal estrogen for provoked vestibulodynia in breast cancer survivors: A delicate balance of risk and relief.

The use of vaginal estrogen for provoked vestibulodynia in breast cancer survivors: A delicate balance of risk and relief.

Recurrent venous thromboembolism and vaginal estradiol in women with prior venous thromboembolism: A nested case-control study.

Whether vaginal estradiol use is associated with an increased risk of recurrent venous thromboembolism (VTE) in women with prior VTE is unknown. We sought to evaluate the association between vaginal estradiol use and recurrent VTE in women with prior VTE. We performed a nationwide nested case-control study among 44 024 women aged ≥45 years who developed a first VTE without a history of vaginal estrogen use prior to VTE diagnosis. Cases with recurrent VTE were matched 1:2 on birth year with controls using incidence density sampling. Exposure to vaginal estradiol tablets was categorized into current use (0-2 months before index), prior use (2-24 months before index) and past use (more than 24 months prior to index). We identified 5066 cases and 10 127 age-matched controls. In fully adjusted analysis vaginal estrogen was not associated with recurrent VTE with a hazard ratio of 0.75, p = .07 for current use, 0.83, p = .13 for prior use, and 1.24, p = .06 for past use. Use of vaginal estradiol tablets in women with prior VTE was not associated with an increased rate of recurrent VTE. Our study indicates that vaginal estradiol therapy is unlikely to increase risk of recurrent VTE in women with prior VTE.

(071) IMPROVING TRAINEE COMFORT IN ASSESSMENT AND MANAGEMENT OF FEMALE SEXUAL HEALTH AND MENOPAUSE THROUGH AN INTERACTIVE WORKSHOP

Abstract Introduction Concerns related to female sexual health and menopause are common in clinical practice, but these topics are often inadequately covered during training. Many medical schools and residency programs lack a formal curriculum, and trainees in internal medicine, family medicine, and obstetrics and gynecology often graduate feeling uncertain in their management of these conditions. Objective Improve resident comfort with assessment and management of female sexual health and menopause through an interactive workshop. Methods We created a 90-minute, interactive workshop focused on female sexual health and menopause. Residents in internal medicine at a large academic medical center were invited to participate. A multidisciplinary group including physicians, advanced practice providers, registered nurses and a certified sex therapist were recruited to lead the workshop. Results Participants rotate through three 30-minute sessions targeted to learning objectives. One session focuses on conducting a symptom-based pelvic exam. A 3-dimensional model is used to review the anatomy of the female pelvic floor and demonstrate physical exam techniques to evaluate vaginal and vulvar symptoms, pelvic pain, and dyspareunia. Diagnostic skills include vulvar inspection to assess for skin and mucosal changes, cotton swab test of the vestibule, and assessment of pelvic floor musculature. A second session focuses on the genitourinary syndrome of menopause (GSM). The pathophysiology, presentation and treatment of GSM is introduced. Next, registered nurses with expertise in female sexual health and menopause lead an interactive demonstration of vaginal moisturizers and lubricants. Advice for counseling patients on the proper use and application of vaginal estrogens is also reviewed. The final session focuses on sexual health counseling, including sexual history-taking skills. Participants are taught about the domains of sexual function, female sexual response cycle, types of desire, patient resources, and sexual aids. Feedback following the initial iteration of this workshop was very positive. All participants felt that the experience was an effective use of time, would recommend it to others, and were confident in their ability to apply skills to their clinical practice. Conclusions This interactive workshop led by a multidisciplinary group of providers aims to improve trainee comfort in evaluation and management of female sexual health and menopause. Given the commonplace nature of these topics in primary care and paucity of existing curricula, consideration could be given to the inclusion of a similar educational experience into internal medicine, family medicine and/or obstetrics and gynecology residency programs. Disclosure No.

Operative Complications, Vaginal Bleeding, and Practice Considerations for Patients on Testosterone Undergoing Gender-Affirming Hysterectomy

Study ObjectiveTo evaluate operative complications and healthcare utilization in transgender patients on testosterone undergoing minimally invasive gender-affirming hysterectomy compared to control patients. DesignWe performed a retrospective cohort study. Operative reports were used to gather information on intraoperative complications. We collected information on postoperative complications, electronic medical record (EMR) messages, phone calls, emergency department utilization, and clinic visits through a 90-day postoperative period. Healthcare utilization reasons were categorized as vaginal bleeding, pain, vaginal discharge, dysuria, urinary retention, bowel concern, incision concern, or other. SettingTertiary care academic medical center. PatientsPatients aged 18 to 55 who underwent a benign minimally invasive hysterectomy with or without oophorectomy performed between January 2014 and December 2022. The testosterone-using cohort consisted of patients who had a gender identity of male, transgender male, genderqueer, or nonbinary with documented testosterone use prior to surgery (n = 88). The control cohort consisted of patients who identified as female, genderqueer, or nonbinary with no documented testosterone use (n = 242). InterventionsNot applicable. Measurements and Main ResultsPatients using testosterone were younger, had a lower body mass index, lower American Society of Anesthesiologists class, and were more likely to be nulliparous. The median time patients used testosterone was 2.5 years (1.5–5.0). Patients on testosterone are at increased risk of intraoperative perineal lacerations requiring repair (RR 3.3, CI 95% [1.03–10.5]). A higher number of patients on testosterone reported vaginal bleeding via EMR message or phone call (RR 1.74 CI 95% [1.1–2.7]) compared to controls. No difference in reasons for emergency department visits was noted. The use of postoperative vaginal estrogen started at the postoperative visit was more frequent in the testosterone-using patients (7 [8.0%] vs 4 [1.7%], p = .01). ConclusionThis study demonstrates that testosterone use preoperatively may increase risk of intraoperative vaginal laceration requiring repair. Testosterone use also correlates with increased reports of vaginal bleeding through EMR message, phone call, and clinic visit. These results contribute new evidence to include in preoperative counseling and support existing evidence surrounding the safety of gender-affirming hysterectomy.

Does vaginal estrogen use increase the risk for adverse cardiovascular outcomes?

NO. In general, nonoral estrogen use for menopausal symptoms is associated with a lower cardiovascular (CV) risk profile than oral estrogen use (strength of recommendation [SOR], B; meta-analysis of cohort studies). Vaginal estrogen use is associated with lower risk for coronary heart disease (CHD) and similar risk for myocardial infarction (MI), stroke, and deep vein thrombosis/pulmonary embolism (DVT/ PE) compared with nonuse (SOR, B; cohort studies). Vaginal estrogen therapy also is associated with lower CV-related mortality for 3 to 5 years compared withnonuse (SOR, B; cohort study). No high-quality randomized trials address this topic.

Genitourinary Syndrome of Menopause in Breast Cancer Survivors: Current Perspectives on the Role of Laser Therapy.

Genitourinary syndrome of menopause (GSM) is a frequent consequence of iatrogenic menopause or anti-estrogenic adjuvant therapies in breast cancer survivors (BCSs). GSM may profoundly affect sexual health and quality of life, and a multidimensional unique model of care is needed to address the burden of this chronic heterogeneous condition. Severe symptoms may be insufficiently managed with non-hormonal traditional treatments, such as moisturizers and lubricants, recommended as the first-line approach by current guidelines, because concerns exist around the use of vaginal estrogens, particularly in women on aromatase inhibitors (AIs). Vaginal laser therapy has emerged as a promising alternative in women with GSM who are not suitable or do not respond to hormonal management, or are not willing to use pharmacological strategies. We aim to systematically review current evidence about vaginal laser efficacy and safety in BCSs and to highlight gaps in the literature. We analyzed results from 20 studies, including over 700 BCSs treated with either CO2 or erbium laser, with quite heterogeneous primary outcomes and duration of follow up (4 weeks-24 months). Although evidence for laser efficacy in BCSs comes mostly from single-arm prospective studies, with only one randomized double-blind sham-controlled trial for CO2 laser and one randomized comparative trial of erbium laser and hyaluronic acid, available data are reassuring in the short term and indicate effectiveness of both CO2 and erbium lasers on the most common GSM symptoms. However, further studies are mandatory to establish long-term efficacy and safety in menopausal women, including BCSs.

(007) The Safety of Vaginal Estrogen Therapy for Genitourinary Syndrome of Menopause in Women with a History of Breast Cancer – A Claims Database Analysis

Abstract Introduction Systemic treatment for breast cancer (BC) may result in genitourinary syndrome of menopause (GSM) in up to 70% of postmenopausal BC survivors. Though systemic estrogen therapy is usually avoided in these patients, vaginal estrogen therapy may be prescribed to treat GSM symptoms. However, few eligible patients with GSM and history of BC are prescribed vaginal estrogen due to concern for cancer recurrence. Objective Our objective was to assess the recurrence rates of BC by vaginal estrogen therapy status in women diagnosed with GSM with a history of BC using a large US claims database. Methods A US health research network (the TriNetX Diamond Network) of over 200 million patients was queried from 2009 to 2022. Females with a diagnosis of BC (C50, Z86.000) within the five years before an initial GSM diagnosis (ICD-10 N90.5, N95.2) were included. Patients who underwent mastectomy (1015054), radiation oncology treatment (1010843), and/or chemotherapy (1002) within three months prior to the diagnosis of GSM were excluded as they were considered to have active disease. Recurrence was defined as the need for mastectomy, radiation, or chemotherapy within three months to five years after initiating vaginal estrogen therapy for GSM. We excluded women diagnosed with cancers other than BC in the 5 years prior to or after their initial GSM diagnosis. The study cohort included those with ≥3 vaginal estrogen (GU500) prescriptions, while the control cohort only included women without vaginal estrogen prescriptions. Propensity-matching between the cohorts for age, ethnicity, race, family history of breast neoplasm (Z80.3), overweight and obesity (E66), hormone replacement therapy (Z79.890), and tobacco usage (Z72.0) was conducted. A sub-analysis by positive estrogen receptor (+ER) status (Z17.0), when available, was performed. Results Amongst females with GSM following a history of BC, 2,113 (5%) received ≥3 vaginal estrogen prescriptions, while 40,019 patients (95%) didn’t receive any vaginal estrogen prescriptions. Amongst those with a +ER status, 410 females (3.9%) received ≥3 vaginal estrogen prescriptions, while 10,182 (96.1%) didn’t receive any vaginal estrogen prescriptions. Compared to matched controls, females with ≥3 vaginal estrogen prescriptions (n=2,111) had similar risks of mastectomy procedures (relative risk (RR) 1.06 [95% CI 0.54, 2.06]), chemotherapy (RR 1.16 [0.98, 1.37]), and radiation treatment (RR 1.06 [0.54, 2.11]) within three months to five years following the first estrogen prescription (Table 1). Individuals with a +ER status and ≥3 vaginal estrogen prescriptions (n=409) had a similar risk of mastectomy procedures, chemotherapy, or radiation treatment (RR 1.07 [0.86, 1.33]) within three months to five years following the first prescription compared to matched controls (Table 1). Conclusions In this large claims-based analysis, we found similar risks of mastectomy, chemotherapy, and radiation treatment, which serve as proxies for recurrence, after the use of vaginal estrogen for GSM in women with a personal history of BC within the five years prior to their GSM diagnosis. These results suggest that vaginal estrogen therapy in women with GSM and history of BC is not associated with an increased risk of BC recurrence and may hence be safe. Disclosure No

MP34-06 THE ROLE OF MICROGENDX TESTING IN PATIENTS WITH LOWER URINARY TRACT SYMPTOMS AND NEGATIVE STANDARD URINE CULTURES

You have accessJournal of UrologyCME1 Apr 2023MP34-06 THE ROLE OF MICROGENDX TESTING IN PATIENTS WITH LOWER URINARY TRACT SYMPTOMS AND NEGATIVE STANDARD URINE CULTURES Rahul Dutta, Wyatt Whitman, Maxwell Sandberg, Stephen Walker, and Catherine Matthews Rahul DuttaRahul Dutta More articles by this author , Wyatt WhitmanWyatt Whitman More articles by this author , Maxwell SandbergMaxwell Sandberg More articles by this author , Stephen WalkerStephen Walker More articles by this author , and Catherine MatthewsCatherine Matthews More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003268.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with acute lower urinary tract symptoms (LUTS) and a negative standard urinary culture are challenging to manage. Some may have identifiable organisms on urinary polymerase-chain reaction (PCR) testing or next-generation DNA sequencing (NGS). We sought to better understand the relationship between patients with negative UC and positive (with an identifiable microbe) PCR/NGS that had treatment for LUTS directed towards the organism(s) on PCR/NGS. METHODS: Patients from a single academic center for which a MicroGenDX PCR/NGS sample was analyzed were retrospectively reviewed. Relationships between demographics, UC and urinalysis data, symptomatology, treatment data, and comorbidities were analyzed. RESULTS: A total of 122 patients were reviewed, of which 116 (95%) had identifiable bacteria and 17 (14%) had identifiable fungi on urinary PCR/NGS. Of these, 95 (81% female) had both negative UC and identifiable microbes on PCR/NGS and were therefore included in the following analysis. The most common reasons for urologic consultation were recurrent urinary tract infection (UTI, 27%), stone disease (21%), and LUTS (18%). Leukocytes were identified on 44% of patients who had a urinalysis at the time of PCR/NGS with negative UC. Forty-seven (54%) patients were treated with antimicrobials following PCR/NGS and 25 of them (53%) had resolution or improvement in their symptoms. There was no association between treatment success and gender, interstitial cystitis, stone disease, diabetes mellitus, vaginal prolapse beyond the hymen, menopausal status, vaginal estrogen use, or overactive bladder syndrome (p>0.05). There was no association between the presence of moderate or greater leukocytes on urinary dipstick and likelihood of symptomatic resolution with treatment (p>0.05). There was a trend to increased likelihood of symptomatic resolution in patients with identifiable fungi on UPCR (p=0.1131). CONCLUSIONS: In the small present study, most patients with lower urinary tract symptoms and a negative standard urine culture have identifiable pathologic microbes on urinary PCR/NGS testing. The clinical utility of PCR/NGS testing, however, is unclear as symptomatic improvement with targeted antimicrobial treatment occurred in only approximately half of these patients. No relationships with treatment success, urinalysis findings, or common medical comorbidities were found. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e461 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rahul Dutta More articles by this author Wyatt Whitman More articles by this author Maxwell Sandberg More articles by this author Stephen Walker More articles by this author Catherine Matthews More articles by this author Expand All Advertisement PDF downloadLoading ...

Surgeon Counseling Regarding Return to Sexual Activity After Pelvic Reconstructive Surgery.

Patients highly value surgeon counseling regarding the first sexual encounters after pelvic reconstructive surgery. We performed a qualitative analysis of usual surgeon counseling regarding return to sexual activity after surgery for pelvic organ prolapse and/or urinary incontinence. Participating surgeons provided a written description of their usual patient counseling regarding return to sexual activity after pelvic organ prolapse or urinary incontinence surgery. Counseling narratives were coded for major themes by 2 independent reviewers; disagreements were arbitrated by the research team. Analysis was performed utilizing Dedoose software and continued until thematic saturation was reached. Twenty-two surgeons participated, and thematic saturation was reached. Six major themes were identified: "Safety of Intercourse," "Specific Suggestions," "Surgical Sequelae," "Patient Control," "Partner Related," "Changes in Experience," and "No Communication." Nearly all participating surgeons included counseling on the safety of intercourse and reassurance that intercourse would not harm the surgical repair. Specific suggestions included different positions, use of lubrication, vaginal estrogen use, specific products/vendors, alternatives to (vaginal) intercourse, and the importance of foreplay. Surgical sequelae discussion included possible interventions for complications, such as persistent sutures in the vagina, abnormal bleeding, or de novo dyspareunia. Counseling regarding changes to the patient's sexual experience ranged from suggestion of improvement to an anticipated negative experience. Surgeons more commonly advised patients that their sexual experience would be worsened or different from baseline; discussion of improvement was less frequent. Surgeon counseling regarding the postoperative return to sexual activity varies among pelvic reconstructive surgeons. Most reassure patients that intercourse is safe after surgery.

Association of Vaginal Estradiol Tablet With Serum Estrogen Levels in Women Who Are Postmenopausal

Half of women who are postmenopausal have genitourinary discomfort after menopause. Recommended therapies include low-dose vaginal estrogen. Individuals with a history of breast cancer or venous thromboembolism may have concerns about the safety of this intervention. To compare serum estrogen concentrations with the use of vaginal estrogen, 10 μg, tablet vs placebo in women who are postmenopausal. This is a secondary, post hoc analysis of data from a randomized clinical trial of treatment for moderate to severe genitourinary syndrome in women who are postmenopausal. The study was conducted at Kaiser Permanente Washington Health Research Institute and the University of Minnesota from April 11, 2016, to April 23, 2017. Measurements and data analysis were performed from November 3, 2020, to September 23, 2022. Participants were randomly assigned to vaginal estradiol tablet (10 μg/d for 2 weeks and then twice weekly) plus placebo gel (3 times weekly) or dual placebo for 12 weeks. In this post hoc analysis, baseline and week 12 serum estradiol, estrone, and sex hormone-binding globulin (SHBG) concentrations were measured by a chemiluminescent assay. Week 12 values of the 3 analytes were compared by baseline participant characteristics. Linear models compared week 12 estradiol concentrations between treatment groups, adjusted for baseline characteristics. A total of 174 women, mean (SD) age 61 (4) years, were included. Those in the estrogen group (n = 88) were more likely to have higher geometric mean (SD) week 12 serum estradiol concentrations (4.3 [2.2 pg/mL]) than those in the placebo group (n = 86) (3.5 [2.1] pg/mL) (P = .01). Adjusted for pretreatment hormone concentrations, age, clinical site, and body mass index, assignment to the estrogen vs placebo treatment group was significantly associated with higher week 12 estradiol concentrations (23.8% difference; 95% CI, 6.9%-43.3%). Most (121 of 174 [69.5%]) participants had enrollment serum estradiol concentrations higher than 2.7 pg/mL. Of women starting treatment at estradiol levels lower than or equal to 2.7 pg/mL, 38.1% (8 of 21) in the estrogen group and 34.4% (11 of 32) in the placebo group had estradiol concentrations higher than 2.7 pg/mL after 12 weeks of study participation (P = .78). Treatment assignment was not associated with week 12 estrone or SHBG concentrations. In this secondary analysis of a randomized clinical trial, a significant, although small, increase in serum estradiol levels was noted after 12 weeks of vaginal estrogen administration. The clinical relevance of this small increase is uncertain. ClinicalTrials.gov Identifier: NCT02516202.

Vaginal Estrogen Therapy for Vulvovaginal Atrophy in Women with a Personal History of Breast Cancer – A Claims Database Analysis

ABSTRACT Introduction Systemic therapies for breast cancer – selective estrogen receptor modulators (SERM), aromatase inhibitors (AI), oophorectomy, and chemotherapies – often result in vulvovaginal atrophy (VVA or atrophic vaginitis), in up to 70% of postmenopausal breast cancer survivors. While systemic estrogen therapy is often avoided in these patients, vaginal estrogen therapy is a safe treatment option that can be used to treat VVA symptoms in breast cancer survivors. Objective Our objective is to assess the use of vaginal estrogen for women with a diagnosis of VVA and a personal history of breast cancer using a large US claims database. Methods The TriNetX Diamond network database was queried: a US health research network of 190 million patients, encompassing healthcare encounters and prescriptions between 2009-2021. Females with a diagnosis of postmenopausal atrophic vaginitis or atrophy of the vulva (ICD-10 N95.2, N90.5) were included. Of these, women with breast cancer (C50 or Z86.000) were included if the diagnosis was at least 1 month prior to VVA diagnosis. Estrogen receptor status was collected when available (ICD-10 Z17.0, Z17.1). Prescriptions for treatment of VVA were included if prescribed within 1 year of VVA diagnosis. Incidence of vaginal estrogen use in patients with a history of breast cancer was determined for 2013-2015, 2016-2018, and 2019 to present. Results A total of 2,159,766 women with VVA were identified; of whom, 4.8% (n=104,327) had a personal history of breast cancer.Vaginal estrogen prescriptions were less frequent prescribed to women with history of breast cancer compared to women without (11% vs 22%, p<0.01, Table 1). Incidence rate of vaginal estrogen prescriptions for women with VVA and history of breast cancer remained stable around 10-11% from 2013 to present. 25,410 women with VVA and history of breast cancer had positive estrogen receptor status (ER+) and 4,893 had negative estrogen receptor status (ER-). There was no difference in vaginal estrogen prescribing between ER+ and ER- patients (7.4% vs 8.4%). Conclusions While vaginal estrogen can be safely used in women with VVA and personal history of breast cancer, it is prescribed for few eligible patients. Barriers to prescribing and using vaginal estrogen in this population should be explored, in order to significantly improve quality of life for those living with vulvovaginal atrophy. Disclosure No

PD44-12 VAGINAL ESTROGEN THERAPY FOR GENITOURINARY SYNDROME OF MENOPAUSE (GSM) IN WOMEN WITH A PERSONAL HISTORY OF BREAST CANCER - A CLAIMS DATABASE ANALYSIS

You have accessJournal of UrologyCME1 May 2022PD44-12 VAGINAL ESTROGEN THERAPY FOR GENITOURINARY SYNDROME OF MENOPAUSE (GSM) IN WOMEN WITH A PERSONAL HISTORY OF BREAST CANCER - A CLAIMS DATABASE ANALYSIS Kathryn Dumas, Sajya Singh, Jaden R. Kohn, Taylor P. Kohn, and Marisa Clifton Kathryn DumasKathryn Dumas More articles by this author , Sajya SinghSajya Singh More articles by this author , Jaden R. KohnJaden R. Kohn More articles by this author , Taylor P. KohnTaylor P. Kohn More articles by this author , and Marisa CliftonMarisa Clifton More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002605.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Systemic therapies for breast cancer - selective estrogen receptor modulators (SERM), aromatase inhibitors (AI), and chemotherapies - can result in genitourinary syndrome of menopause (previously recognized as vulvovaginal atrophy) for up to 70% of postmenopausal breast cancer survivors. While systemic estrogen therapy is often avoided in these women, vaginal estrogen can be safely used to treat GSM symptoms. Our objective is to assess the use of vaginal estrogen for women with a diagnosis of GSM and a personal history of breast cancer using a large US claims database. METHODS: The TriNetX Diamond network database was queried: a US health research network of 190 million patients, encompassing healthcare encounters and prescriptions between 2009-2021. Females with a diagnosis of postmenopausal atrophic vaginitis or atrophy of the vulva (ICD-10 N95.2, N90.5) were included. Of these, women with breast cancer (C50 or Z86.000) were included if the diagnosis was at least 1 month prior to VVA diagnosis. Estrogen receptor status was collected when available (ICD-10 Z17.0, Z17.1). Prescriptions for treatment of GSM were included if prescribed the day of VVA diagnosis up to 1 year after index diagnosis. Incidence of vaginal estrogen use in patients with a history of breast cancer was determined for 2013-2015, 2016-2018, and 2019 to present. RESULTS: A total of 2,159,766 women with GSM were identified; of whom, 4.8% (n=104,327) had a personal history of breast cancer. Vaginal estrogen prescriptions were less frequent in women with history of breast cancer compared to women without (11% vs 22%, p<0.01, Table 1). Incidence rate of vaginal estrogen prescriptions for women with GSM and history of breast cancer remained stable around 10-11% from 2013 to present. 25,410 women with GSM and history of breast cancer had positive estrogen receptor status (ER+) and 4,893 had negative estrogen receptor status (ER-). There was no difference in vaginal estrogen prescribing between ER+ and ER- patients (7.4% vs 8.4%). CONCLUSIONS: While vaginal estrogen can be safely used in women with GSM and personal history of breast cancer, it is prescribed for few eligible patients. Barriers to use of vaginal estrogen in this population should be explored to optimize patient’s quality of life. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e712 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kathryn Dumas More articles by this author Sajya Singh More articles by this author Jaden R. Kohn More articles by this author Taylor P. Kohn More articles by this author Marisa Clifton More articles by this author Expand All Advertisement PDF DownloadLoading ...

Vaginal estrogen: An option to be considered for postmenopausal women

The author reviews the use of vaginal estrogen for postmenopausal women affected by the genitourinary syndrome of menopause, explaining that it is safe and effective for most and that women’s health nurse practitioners are well positioned to recognize the need for vaginal estrogen, educate the patient on safety concerns, and prescribe it when indicated.

Measurement of the vaginal wall thickness by transabdominal and transvaginal ultrasound of women with vaginal laxity: a cross-sectional study.

An objective diagnostic method to understand vaginal laxity (VL) is still missing. The aim of our study is to determine whether vaginal wall thickness (VWT) measured by ultrasound may differ according to the abdominal or vaginal techniques and to assess whether clinical variables are associated with vaginal measurements of women with VL. A cross-sectional study conducted at a tertiary hospital included 82 women aged ≥ 18 years with VL complaints assessed by the Vaginal Laxity Questionnaire. Women who reported severe comorbidities or vulvovaginal disorders, previous treatment for VL, and use of vaginal estrogen in the last 6 months were excluded. Participants reporting VL underwent transabdominal (TAUS) and transvaginal ultrasound (TVUS) and physical examination and answered validated questionnaires. Descriptive data were given as mean and standard deviation, median (range), and absolute and relative frequency. The significance level adopted for this study was 5%. Sample size calculation was not performed for the present study. Mean age was 41.20 ± 8.64 years, and most participants were multiparous, with previous vaginal delivery and having vaginal intercourse. A statistically significant difference (up to 3 mm) between TAUS and TVUS measurements of the VWT was found in the proximal, middle-third, and distal compartments. A significant correlation was found between VWT and TAUS or TVUS in the mid-third and distal compartments. A significant correlation was found between the VWT measurements in TVUS and TAUS. Our findings might give the health professional more possibilities for investigating VWT according to patient characteristics.

Predictors for long-term adherence to vaginal pessary in pelvic organ prolapse: a prospective study.

The objective was to investigate the rate of adherence to pessary treatment for pelvic organ prolapse (POP), to identify factors associated with long-term (longer than 1 year) use of vaginal pessaries in Brazilian women with POP and its impact on quality of life (QoL). A prospective observational study assessed 247 consecutive women candidates for a pessary to manage symptomatic POP. Patients were fitted with a ring pessary and follow-up visits were performed at 1, 6, and 12months. Pessary complications and reasons for discontinuation were recorded. Prolapse Quality of Life Questionnaire (P-QoL) was applied at baseline and after 1 year of treatment. We used a logistic regression model for the analyses, with p < 0.05 for significance. A total of 236 women were included in the study, of whom 110 (46.6%) maintained the pessary treatment for longer than 12months. The main reason for pessary discontinuation was the patient opting for surgery (50.8%). Vulvovaginitis was the main long-term complication (44.5%), followed by vaginal ulceration (16.4%) and urinary urgency (10%). No prior hysterectomy (OR = 2.26; 95% CI 1.19-4.31), vaginal estrogen use (OR = 1.94; 95% CI 1.06-3.52), and mean age (OR = 1.03; 95% CI 1.01-1.06) were variables associated with long-term use of vaginal pessary (p < 0.05 for all). Total P-QoL score significantly changed with pessary use (519.1 at baseline and 260 after 12-month treatment, p < 0.00). Our study suggests that no prior hysterectomy, the local estrogen therapy, and age might be factors associated with use of a ring vaginal pessary for longer than 1 year. Long-term pessary users had a significant improvement in their quality of life.

Comparing Urine Specimen Collection Methods for Urinalysis and Culture Agreement: A Paired Sample Design.

The primary aim of this study was to determine if results from clean catch urine specimens agree with results from catheterized specimens in a urogynecology patient population. The secondary aim was to identify clinical scenarios in which catheterized specimens are preferred over clean catch specimens. Both a midstream clean catch and a catheterized specimen were obtained for each participant. Dipstick urinalysis was performed. If either specimen was positive for nitrites, leukocyte esterase, or blood then both were sent for urine culture.Kappa statistics were calculated to measure agreement between the paired specimen data for the total sample and for stratified samples. We agreed to accept clean catch results as preferable to catheterized results if the κ statistic was 0.7 or greater. Three hundred forty-two participants were enrolled. For all participants, the agreement between the paired samples was strong for nitrite (κ = 0.884), moderate for blood and colony count (both κ = 0.656), weak for culture species (κ = 0.566), and minimal for leukocyte esterase (κ = 0.382). When data were stratified for menopause, vaginal estrogen use, body mass index, and prolapse, there were no clinical scenarios in which the κ values were consistently greater than our accepted value of 0.7. Our data indicate that catheterized urine specimens should be used in the evaluation of urinary tract infection or microscopic hematuria in the typical patient presenting to a urogynecology office who is often menopausal, overweight, and may have prolapse.

Methenamine Prophylaxis for Recurrent Urinary Tract Infections in a Tertiary Referral Center

Methenamine hippurate (MH) is a urinary antiseptic, indicated for prophylaxis of recurrent urinary tract infections (UTIs) but with only few and limited studies regarding its efficacy. To help address this knowledge gap we reviewed our experience with MH for UTI prophylaxis, focusing on women with recurrent uncomplicated UTIs. The University of Kentucky electronic health record was queried to identify adults who were prescribed MH from the urology clinic between January 2013 and January 2019. Charts were reviewed to assess patient-reported UTI frequency, demographics and relevant health factors. Treatment success was defined as 0-1 UTI in 6 months or 0-2 UTIs in 1 year. Of 670 patients prescribed MH, 508 did not meet inclusion criteria. The most common reasons for exclusion were complicated UTI, no return visit, treatment nonadherence and insufficient followup time. The primary study population was 162 women with recurrent uncomplicated UTIs: 41 premenopausal and 121 postmenopausal. Success rates with MH were 83% and 77%, respectively. Success rates were not significantly associated with age, diabetes, immune suppression, high-tone pelvic floor dysfunction or (if postmenopausal) vaginal estrogen use. Exploratory study of patients using intermittent catheterization showed success in 20 of 30 patients (67%). MH had high success rates for premenopausal and postmenopausal women with recurrent uncomplicated UTIs. Patients using catheters had lower success rates. Prospective trials would strengthen the evidence to guide decisions for treatment and insurance coverage.

Distinguishing Features of the Urinary Bacterial Microbiome in Patients with Neurogenic Lower Urinary Tract Dysfunction.

We aimed to characterize the urinary microbiome of catheterizing patients with neurogenic lower urinary tract dysfunction (NLUTD) and to evaluate differences based on type of bladder management or frequency of urinary tract infections. This is a prospective, cross-sectional study of urine samples from asymptomatic, catheterizing patients with neurogenic lower urinary tract dysfunction who used either clean intermittent catheterization or indwelling catheters. Patients without symptoms of urinary tract infection provided a catheterized urine sample for urinalysis, culture and bacterial community microbiome analysis. A total of 95 patients submitted urine for analysis, of whom 69 had sufficient sequence reads (>1,203) for microbiome analysis. Cases with low bacterial signal amplification were associated with use of vaginal estrogen, no intradetrusor botulinum toxin A use and no growth on standard urine culture. The most abundant operational taxonomic units were from the phylum Proteobacteria, classified as Enterobacteriaceae and Escherichia. Alpha diversity varied among those who used indwelling catheters vs clean intermittent catheterization, and those who underwent botulinum toxin A injection vs not. On linear discriminate analysis, the relative abundance of the operational taxonomic units identified as Pseudomonas was higher among patients using indwelling catheters relative to clean intermittent catheterization. The operational taxonomic unit identified as Aerococcus was at a higher relative abundance among males compared to females. Enterobacteriaceae and Escherichia were the most abundant genera in the urinary microbiome of patients with neurogenic lower urinary tract dysfunction. Urinary microbiome diversity varied based on bladder management type. Future clinical correlations between microbiome of neurogenic patients and clinical presentation may help guide treatment strategies.

Does administration of vaginal estrogens increase the risk of venous thromboembolism: A case-control study.

Does administration of vaginal estrogens increase the risk of venous thromboembolism: A case-control study.

Recurrent urinary tract infection: Association of clinical profiles with urobiome composition in women.

Clinical profiles of women with recurrent urinary tract infection (RUTI) are correlated with their urinary microbes. This IRB-approved, cross-sectional study enrolled adult women with RUTI. Urine samples (catheterized and voided) underwent culture by expanded quantitative urine culture (EQUC) and standard urine culture (SUC) methods. A validated symptom questionnaire, relevant clinical variables, and EQUC were used to identify symptom clusters and detect associations with specific urinary microbes. Most (36/43) participants were postmenopausal; the average age was 67 years. 51% reported vaginal estrogen use; 51% reported sexual activity. Although single symptoms were not associated with specific urinary microbes, EQUC results were correlated with five distinct clinical profile clusters: Group A: odor, cloudiness, and current vaginal estrogen use (no culture result association). Group B: frequency, low back pain, incomplete emptying, and vaginal estrogen (significantly increased proportion of Lactobacillus-positive cultures). Group C: pain/burning, odor, cloudiness, and urgency (high proportions of UTI-associated microbe-positive cultures). Group D: frequency, urgency, pain/burning, and current vaginal estrogen use (increased number of no growth cultures). Group E: frequency, urgency, pain/burning, odor, overactive bladder, and sexually active (significantly increased proportion of Klebsiella-positive cultures). Distinct clinical profiles are associated with specific urinary microbes in women with RUTI. Refined assessments of clinical profiles may provide useful insights that could inform diagnostic and therapeutic considerations.