How is dyspareunia treated in menopausal women?

Updated: Jun 06, 2018
  • Author: PonJola Coney, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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Dyspareunia is a condition caused by vulvar and vaginal atrophy in menopausal women and resulting in moderate to severe pain. Several palliative treatments exist for this condition, lessening the symptoms which are due to inadequate lubrication and lowered estrogen levels. Topical estrogen cream provides one option. Another includes ospemifene (Osphena), an oral estrogen agonist/antagonist which acts like estrogen on the vaginal lining, but differs from estrogen in that it has decreased risk for harmful effects on the endometrial or breast tissues. Disadvantages to this particular therapy include hot flashes risk of stroke or blood clots.

In November 2016, the FDA approved intravaginal DHEA for management of moderate- to- severe dyspareunia, a symptom of vulvar and vaginal atrophy, caused by menopause. DHEA is an inactive steroid found endogenously that is converted into active androgens and/or estrogens. Intravaginal DHEA, known as Intrarosa (prasterone intravaginal) has been found to result in clinically significant reductions in dyspareunia in menopausal women. It represents an alternative therapy for management of dyspareunia. [97, 98]

Intravaginal estrogen preparations are available to treat menopausal vasomotor symptoms, vulvar and vaginal atrophy, and dyspareunia. Estradiol vaginal inserts (Imvexxy) were approved by the FDA in May 2018 for the treatment of moderate-to-severe dyspareunia due to menopause. Approval was based on the results of the REJOICE trial, a Phase 3, randomized, double-blind, placebo-controlled study that evaluated the safety and efficacy of estradiol vaginal inserts compared to placebo from baseline to week 12. Compared with placebo, all three doses (4, 10, or 25 mcg) of estradiol vaginal inserts significantly improved percentages of superficial and parabasal cells, vaginal pH, and severity of dyspareunia. Changes in cytology, pH, and dyspareunia were also significant at weeks 2, 6, and 8. Vaginal dryness and vaginal itching/irritation improved. Sex hormone binding globulin concentrations did not change with treatment. [109]

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