Journal article
The role of androgens in the treatment of genitourinary syndrome of menopause (GSM): International Society for the Study of Women's Sexual Health (ISSWSH) expert consensus panel review
Menopause (New York, N.Y.), v 25(7), pp 837-847
01 Jul 2018
PMID: 29870471
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Objective: The objective of this consensus document is to broaden the perspective on clinical management of genitourinary syndrome of menopause to include androgens.
Methods: A modified Delphi method was used to reach consensus among the 14 international panelists representing multiple disciplines and societies.
Results: Menopause-related genitourinary symptoms affect over 50% of midlife and older women. These symptoms have a marked impact on sexual functioning, daily activities, emotional well-being, body image, and interpersonal relations. Tissues in the genitourinary system are both androgen and estrogen-dependent. The clitoris, vestibule, including minor and major vestibular glands, urethra, anterior vaginal wall, periurethral tissue, and pelvic floor are androgen-responsive. Historically, treatment of postmenopausal genitourinary symptoms involved both androgens and estrogens. This subsequently gave rise to predominantly estrogen-based therapies. More recently, double-blind, placebo-controlled clinical trials have demonstrated that local vaginal dehydroepiandrosterone improves symptoms in postmenopausal women, including moderate to severe dyspareunia. Limited data suggest that systemic testosterone treatment may improve vaginal epithelial health and blood flow. Open-label studies that have used high doses of intravaginal testosterone in the presence of aromatase inhibitor therapy for breast cancer have resulted in supraphysiological serum testosterone levels, and have been reported to lower vaginal pH, improve the vaginal maturation index, and reduce dyspareunia.
Conclusions: Vaginal dehydroepiandrosterone, hypothesized to enhance local production of both androgen and estrogen, is effective for the management of dyspareunia in menopause. Vaginal testosterone offers potential as a treatment for genitourinary syndrome of menopause, but more studies are needed.
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Details
- Title
- The role of androgens in the treatment of genitourinary syndrome of menopause (GSM): International Society for the Study of Women's Sexual Health (ISSWSH) expert consensus panel review
- Creators
- James A. Simon - George Washington UniversityIrwin Goldstein - Pomerado HospitalNoel N. Kim - College Station Medical CenterSusan R. Davis - Monash UniversitySusan Kellogg-Spadt - College Station Medical CenterLior Lowenstein - Rambam Health Care CampusJoAnn V. Pinkerton - North American Menopause SocietyCynthia A. Stuenkel - University of California, San DiegoAbdulmaged M. Traish - Boston UniversityDavid F. Archer - Eastern Virginia Medical SchoolGloria Bachmann - Rutgers, The State University of New JerseyAndrew T. Goldstein - George Washington UniversityRossella E. Nappi - University of PaviaLinda Vignozzi - University of Florence
- Publication Details
- Menopause (New York, N.Y.), v 25(7), pp 837-847
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 11
- Grant note
- AMAG Pharmaceuticals
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Obstetrics and Gynecology
- Web of Science ID
- WOS:000442315700019
- Scopus ID
- 2-s2.0-85050095350
- Other Identifier
- 991021932793204721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Obstetrics & Gynecology