Menopause Society Endorses Multifaceted DHEA Therapy

The North American Menopause Society (NAMS) announces publication of its 2020 Genitourinary Syndrome of Menopause (GSM) Position Statement. The new recommendations reflect the healthcare community’s most recent and proven safe and effective therapies for treating women with GSM, including intravaginal dehydroepiandrosterone (DHEA), oral ospemifene, and a low-dose estradiol vaginal insert. The position statement is available online and will be published in the September issue of Menopause, the journal of NAMS.

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Genitourinary syndrome of menopause affects approximately 27% to 84% of postmenopausal women and can significantly impair health, sexual function, and quality of life. Unfortunately, it remains underdiagnosed and undertreated, leaving many women to suffer silently. The most commonly reported symptoms include irritation of the vulva, inadequate vaginal lubrication, burning, dysuria, dyspareunia, and vaginal discharge.

In developing the new position statement, NAMS reviewed current data on a wide variety of proposed treatments to determine their efficacy and safety before making recommendations. According to the 2020 position statement, first-line therapies for less-severe symptoms include nonhormone vulvar and vaginal lubricants with sexual activity and long-acting vaginal moisturizers used regularly. Prescription therapies include low-dose vaginal estrogens, vaginal DHEA inserts, and oral ospemifene. For women with moderate to severe dyspareunia associated with GSM and with concurrent vasomotor symptoms, transdermal and oral hormone therapy are effective options.

The position statement additionally points out that long-term studies on the endometrial safety of vaginal estrogen, vaginal DHEA, and ospemifene are lacking. In addition, NAMS believes there are insufficient placebo-controlled trials of energy-based therapies, including laser, to draw conclusions on their efficacy and safety or to make treatment recommendations for those devices.

The new position statement can be found online at https://www.menopause.org/docs/default-source/default-document-library/2020-gsm-ps.pdf.

“Since our last position statement on this topic published in 2013, there have been important additions in terms of safe and effective therapeutic options for women with GSM,” says Dr. Stephanie S. Faubion, NAMS Medical Director and member of the Editorial Panel of the Position Statement. “NAMS has reviewed existing data on these therapies as well as on emerging treatment modalities such as energy devices. What hasn’t changed is that GSM remains underdiagnosed and undertreated and continues to be a significant quality-of-life issue for women. NAMS endorses educating about and screening for GSM in all perimenopausal and postmenopausal women.”

Conclusion/ Clinicians can resolve many distressing genitourinary symptoms and improve sexual health andthe quality of life of postmenopausal women by educating women about, diagnosing, and appropriately managingGSM. Choice of therapy depends on the severity of symptoms, the effectiveness and safety of treatments for theindividual patient, and patient preference. Nonhormone therapies available without a prescription provide sufficient relief for most women with mild symptoms. Low-dose vaginal estrogens, vaginal DHEA, systemic estrogen therapy, and ospemifene are effective treatments for moderate to severe GSM. When low-dose vaginal estrogen or DHEA orospemifene is administered, a progestogen is not indicated; however, endometrial safety has not been studied in clinical trials beyond 1 year. There are insufficient data at present to confirm the safety of vaginal estrogen or DHEA or ospemifene in women with breast cancer; management of GSM should consider the woman’s needs and therecommendations of her oncologist

Source: 2020 Genitourinary Syndrome of Menopause (GSM) Position Statement. Link to document.