What are the NAMS recommendations on symptomatic vulvovaginal atrophy (VVA) in postmenopausal women?

Updated: Jun 06, 2018
  • Author: PonJola Coney, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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In September 2013, the North American Menopause Society (NAMS) updated and expanded its recommendations regarding symptomatic vulvovaginal atrophy (VVA) in postmenopausal women. [17, 18] Among the recommendations are the following [18] :

  • Discuss with patients how VVA is diagnosed and treated

  • For mild symptoms, use over-the-counter products such as vaginal lubricants and moisturizers

  • Depending on symptom severity, use prescription therapies, such as vaginal estrogen, hormone therapy, and ospemifene (a selective estrogen-receptor modulator that is indicated for dyspareunia),

  • Do not use progesterone with local administration of low-dose estrogen in women without a uterus and, generally, in those with an intact uterus

NAMS also noted the following [18] :

  • Vaginal microflora affect VVA symptoms

  • Therapy is based on the patient’s symptom severity and preference, as well as the clinical efficacy and safety of the treatment

  • Estrogen remains the most effective therapy for moderate to severe symptomatic VVA, but there are no head-to-head studies between estrogen and ospemifene

  • Long-term studies regarding endometrial safety and use of local estrogen and ospemifene are still needed

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