Zusammenfassung
Die vulvovaginale Atrophie (VVA) ist ein im klinischen Alltag häufig unterschätzter Aspekt der weiblichen Gesundheit. Zahlreiche Arbeiten haben sich in den letzten Jahren mit der Pathophysiologie der symptomatischen VAA bei peri- und postmenopausalen Frauen auseinandergesetzt. Neben den physischen Aspekten werden die Auswirkungen der VVA auf die Lebensqualität und das psychosoziale Wohlbefinden diskutiert. Der vorliegende Beitrag soll einen Überblick über den aktuellen Stand der Wissenschaft zur endokrinen Therapie der VVA liefern.
Abstract
Vulvovaginal atrophy (VVA) is a frequently underestimated aspect of female health in the clinical routine. Numerous studies in recent years have dealt with the pathophysiology of symptomatic VAA in perimenopausal and postmenopausal women. In addition to the physical aspects, the impact of VAA on the quality of life and psychosocial well-being are discussed. This article provides an overview of the current state of the art of endocrine treatment of VVA.
Literatur
Agrawal P, Singh SM, Able C et al (2023) Safety of Vaginal Estrogen Therapy for Genitourinary Syndrome of Menopause in Women With a History of Breast Cancer. Obstet Gynecol 142:660–668. https://doi.org/10.1097/AOG.0000000000005294
Anglim B, Phillips C, Shynlova O et al (2021) The effect of local estrogen therapy on the urinary microbiome composition of postmenopausal women with and without recurrent urinary tract infections. Int Urogynecol J. https://doi.org/10.1007/s00192-021-04832-9
Baber RJ, Panay N, Fenton A (2016) 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric 19:109–150. https://doi.org/10.3109/13697137.2015.1129166
Bachmann GA, Nevadunsky NS (2000) Diagnosis and treatment of atrophic vaginitis. Am Fam Physician 61:3090–3096
Bhupathiraju SN, Grodstein F, Stampfer MJ et al (2018) Vaginal estrogen use and chronic disease risk in the Nurses’ Health Study. Menopause 26:603–610. https://doi.org/10.1097/GME.0000000000001284
Biehl C, Plotsker O, Mirkin S (2019) A systematic review of the efficacy and safety of vaginal estrogen products for the treatment of genitourinary syndrome of menopause. Menopause 26:431–453. https://doi.org/10.1097/GME.0000000000001221
Bruyniks N, Biglia N, Palacios S et al (2017) Systematic indirect comparison of ospemifene versus local estrogens for vulvar and vaginal atrophy. Climacteric 20:195–204. https://doi.org/10.1080/13697137.2017.1284780
Chen Y‑Y, Su T‑H, Lau H‑H (2021) Estrogen for the prevention of recurrent urinary tract infections in postmenopausal women: a meta-analysis of randomized controlled trials. Int Urogynecol J 32:17–25. https://doi.org/10.1007/s00192-020-04397-z
Cody JD, Jacobs ML, Richardson K et al (2012) Oestrogen therapy for urinary incontinence in post-menopausal women. Cochrane Database Syst Rev 10:CD1405. https://doi.org/10.1002/14651858.CD001405.pub3
Cold S, Cold F, Jensen M‑B et al (2022) Systemic or Vaginal Hormone Therapy After Early Breast Cancer: A Danish Observational Cohort Study. J Natl Cancer Inst 114:1347–1354. https://doi.org/10.1093/jnci/djac112
Donders G, Neven P, Moegele M et al (2014) Ultra-low-dose estriol and Lactobacillus acidophilus vaginal tablets (Gynoflor(®)) for vaginal atrophy in postmenopausal breast cancer patients on aromatase inhibitors: pharmacokinetic, safety, and efficacy phase I clinical study. Breast Cancer Res Treat 145:371–379. https://doi.org/10.1007/s10549-014-2930-x
Furuhjelm M, Karlgren E, Carlström K (1980) Intravaginal administration of conjugated estrogens in premenopausal and postmenopausal women. Int J Gynaecol Obstet 17:335–339. https://doi.org/10.1002/j.1879-3479.1980.tb00295.x
Gajer P, Brotman RM, Bai G et al (2012) Temporal dynamics of the human vaginal microbiota. Sci Transl Med 4:132ra52. https://doi.org/10.1126/scitranslmed.3003605
Guidozzi F (2013) Estrogen therapy in gynecological cancer survivors. Climacteric 16:611–617. https://doi.org/10.3109/13697137.2013.806471
Heimer GM, Englund DE (1986) Plasma oestriol following vaginal administration: morning versus evening insertion and influence of food. Maturitas 8:239–243. https://doi.org/10.1016/0378-5122(86)90031-9
Hendrix SL, Cochrane BB, Nygaard IE et al (2005) Effects of estrogen with and without progestin on urinary incontinence. JAMA 293:935–948. https://doi.org/10.1001/jama.293.8.935
Heo Y‑A (2019) Prasterone: A Review in Vulvovaginal Atrophy. Drugs Aging 36:781–788. https://doi.org/10.1007/s40266-019-00693-6
Jackson S (2002) The effect of oestradiol on vaginal collagen metabolism in postmenopausal women with genuine stress incontinence. BJOG 109:339–344. https://doi.org/10.1016/S1470-0328(02)01052-2
Kanne B, Jenny J (1991) Lokale Anwendung von schwachdosiertem Östriol und lebensfähigen Döderlein-Keimen in der Postmenopause. Gynakol Geburtshilfliche Rundsch 31:7–13. https://doi.org/10.1159/000271609
Kovachev SM, Kovachev MS (2022) Genitourinary syndrome, local oestrogen therapy and endometrial pathology: a single-centre, randomised study. J Obstet Gynaecol 42:1489–1492. https://doi.org/10.1080/01443615.2021.2006163
Krychman M, Graham S, Bernick B et al (2017) The Women’s EMPOWER Survey: Women’s Knowledge and Awareness of Treatment Options for Vulvar and Vaginal Atrophy Remains Inadequate. J Sex Med 14:425–433. https://doi.org/10.1016/j.jsxm.2017.01.011
Lamont RF, Sobel JD, Akins RA et al (2011) The vaginal microbiome: new information about genital tract flora using molecular based techniques. BJOG 118:533–549. https://doi.org/10.1111/j.1471-0528.2010.02840.x
Lee Y‑K, Chung HH, Kim JW et al (2011) Vaginal pH-balanced gel for the control of atrophic vaginitis among breast cancer survivors: a randomized controlled trial. Obstet Gynecol 117:922–927. https://doi.org/10.1097/AOG.0b013e3182118790
Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe (2018) AWMF: Diagnostik, Therapie und Nachsorge der Patientinnen mit Endometriumkarzinom, Langversion 1.0, AWMF Registernummer: 032/034-OL. http://www.leitlinienprogramm-onkologie.de/leitlinien/endometriumkarzinom. Zugegriffen: 29. Nov. 2021
Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe (2022) AWMF: Endometriumkarzinom, Langversion 2.0, AWMF Registernummer: 032/034-OL
Bride MMB, Rhodes DJ, Shuster LT (2010) Vulvovaginal atrophy. Mayo Clin Proc 85:87–94. https://doi.org/10.4065/mcp.2009.0413
Mattsson LA, Cullberg G (1983) Vaginal absorption of two estriol preparations. A comparative study in postmenopausal women. Acta Obstet Gynecol Scand 62:393–396. https://doi.org/10.3109/00016348309154208
Maurer-Major E (2001) Einfluss von Hormonen auf den Beckenboden. coloproctology 23:272–275. https://doi.org/10.1007/s00053-001-5056-7
McGroarty JA (1993) Probiotic use of lactobacilli in the human female urogenital tract. FEMS Immunol Med Microbiol 6:251–264. https://doi.org/10.1111/j.1574-695X.1993.tb00337.x
Moegele M, Buchholz S, Seitz S et al (2012) Vaginal estrogen therapy in postmenopausal breast cancer patients treated with aromatase inhibitors. Arch Gynecol Obstet 285:1397–1402. https://doi.org/10.1007/s00404-011-2181-6
Montoya TI, Maldonado PA, Acevedo JF et al (2015) Effect of vaginal or systemic estrogen on dynamics of collagen assembly in the rat vaginal wall. Biol Reprod 92:43. https://doi.org/10.1095/biolreprod.114.118638
Mørch LS, Løkkegaard E, Andreasen AH et al (2009) Hormone therapy and ovarian cancer. JAMA 302:298–305. https://doi.org/10.1001/jama.2009.1052
Mueck AO, Ruan X, Prasauskas V et al (2018) Treatment of vaginal atrophy with estriol and lactobacilli combination: a clinical review. Climacteric 21:140–147. https://doi.org/10.1080/13697137.2017.1421923
Nappi RE, Palacios S (2014) Impact of vulvovaginal atrophy on sexual health and quality of life at postmenopause. Climacteric 17:3–9. https://doi.org/10.3109/13697137.2013.871696
Panay N (2015) Genitourinary syndrome of the menopause—dawn of a new era? Climacteric 18(Suppl 1):13–17. https://doi.org/10.3109/13697137.2015.1070564
(2018) Peri- and Postmenopause—Diagnosis and Interventions. Guideline of the German Society of Gynecology and Obstetrics (S‑3 Level, AWMF Registry No. 015-062). http://www.awmf.org/leitlinien/detail/ll/015-062.html. Zugegriffen: 27. Nov. 2021
Portman DJ, Gass MLS (2014) Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and The North American Menopause Society. Climacteric 17:557–563. https://doi.org/10.3109/13697137.2014.946279
redondo-Lopez V, Cook RL, Sobel JD (1990) Emerging role of lactobacilli in the control and maintenance of the vaginal bacterial microflora. Rev Infect Dis 12:856–872. https://doi.org/10.1093/clinids/12.5.856
Rigg LA, Hermann H, Yen SS (1978) Absorption of estrogens from vaginal creams. N Engl J Med 298:195–197. https://doi.org/10.1056/NEJM197801262980406
Samsioe G (1998) Urogenital aging—a hidden problem. Am J Obstet Gynecol 178:S245–S249. https://doi.org/10.1016/S0002-9378(98)70555-1
Santoro N, Komi J (2009) Prevalence and impact of vaginal symptoms among postmenopausal women. J Sex Med 6:2133–2142. https://doi.org/10.1111/j.1743-6109.2009.01335.x
Shim S‑H, Lee SJ, Kim S‑N (2014) Effects of hormone replacement therapy on the rate of recurrence in endometrial cancer survivors: a meta-analysis. Eur J Cancer 50:1628–1637. https://doi.org/10.1016/j.ejca.2014.03.006
Simon J, Nachtigall L, Ulrich LG et al (2010) Endometrial safety of ultra-low-dose estradiol vaginal tablets. Obstet Gynecol 116:876–883. https://doi.org/10.1097/AOG.0b013e3181f386bb
Singh P, Oehler MK (2010) Hormone replacement after gynaecological cancer. Maturitas 65:190–197. https://doi.org/10.1016/j.maturitas.2009.11.017
Sturdee DW, Panay N (2010) Recommendations for the management of postmenopausal vaginal atrophy. Climacteric 13:509–522. https://doi.org/10.3109/13697137.2010.522875
Unlü C, Donders G (2011) Use of lactobacilli and estriol combination in the treatment of disturbed vaginal ecosystem: a review. J Turkish German Gynecol Assoc 12:239–246. https://doi.org/10.5152/jtgga.2011.57
van der Vies J (1982) The pharmacology of oestriol. Maturitas 4:291–299. https://doi.org/10.1016/0378-5122(82)90061-5
Vaughan MH, Mao J, Karstens LA et al (2021) The Urinary Microbiome in Postmenopausal Women with Recurrent Urinary Tract Infections. J Urol 206:1222–1231. https://doi.org/10.1097/JU.0000000000001940
Wierman ME (2007) Sex steroid effects at target tissues: mechanisms of action. Am J Physiol 31:26–33. https://doi.org/10.1152/advan.00086.2006
Wilson JD, Lee RA, Balen AH et al (2007) Bacterial vaginal flora in relation to changing oestrogen levels. Int J STD AIDS 18:308–311. https://doi.org/10.1258/095646207780749583
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L. Bausewein, S. Schüler-Toprak und O. Ortmann geben an, dass kein Interessenkonflikt besteht.
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Brigitte Leeners, Zürich
Olaf Ortmann, Regensburg
Clemens Tempfer, Herne
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Bausewein, L., Schüler-Toprak, S. & Ortmann, O. Endokrine Therapie der vulvovaginalen Atrophie. Gynäkologische Endokrinologie 22, 135–142 (2024). https://doi.org/10.1007/s10304-024-00566-1
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DOI: https://doi.org/10.1007/s10304-024-00566-1