–History and physical, above.
-Genital s/sx from changes in the vulva, vagina, and lower genital tract that are caused by diminished estrogen.
–Pharmacotherapy: Vaginal estrogen, nonhormonal vaginal moisturizers, as well as ospemifene treatment options discussed with the patient as well as benefits and risks and side effects.
-Will try nonhormonal therapy as a 1st line option.Replens Replens vaginal moisturizer. Apply 3 times per week.
-If syndrome doesn’t respond to nonhormonal Rx or if the patient develops a narrow introitus or vagina, we will consider low-dose vaginal estrogen.
-Counseling:
-F/u in 6wks.
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“There is no evidence that using low-dose local estrogen increases the risk of breast cancer recurrence.” AFP 2016
-Genitourinary Syndrome of Menopause (formerly Atrophic Vaginitis and Vulvovaginal atrophy)
Ospemifene is the only nonhormonal treatment approved by the U.S. Food and Drug Administration for dyspareunia due to menopausal atrophy.
“In 2014, a consensus conference endorsed the new term genitourinary syndrome of menopause to replace the terms vulvovaginal atrophy and atrophic vaginitis, partly because the older terminology does not encompass the extent of genital tract symptoms many women experience.”
Reference
Am Fam Physician. 2016 Dec 1;94(11):884-889. http://www.aafp.org/afp/2016/1201/p884.html