Hormonal Treatments and Vaginal Moisturizers for Genitourinary Syndrome of Menopause : A Systematic Review
Authors' conclusion
Vaginal estrogen, vaginal DHEA, oral ospemifene, and vaginal moisturizers may improve some GSM symptoms in the short term. Few long-term data exist on efficacy, comparative effectiveness, tolerability, and safety of GSM treatments.
Study context
- Population
- Postmenopausal women with ≥1 genitourinary syndrome of menopause (GSM) symptom; Randomized controlled trials (RCTs) of ≥8 weeks; Medline, Embase, CINAHL through 11 December 202346 RCTs
- Comparison
- Vaginal estrogen, nonestrogen hormone therapies and vaginal moisturizers vs placebo or no treatment
- Outcome
- GSM symptoms
Methodological detailsno meta-analysis (heterogeneity), certainty of evidence assessed, Risk of bias and data extraction by one reviewer, verified by a second; Certainty of evidence (COE) by one reviewer, verified by consensus, Included RCTs: vaginal estrogen (k = 22), nonestrogen hormones (k = 16), vaginal moisturizers (k = 4), multiple interventions (k = 4)
- No meta-analysis (heterogeneity)
- Certainty of evidence assessed
- Risk of bias and data extraction by one reviewer, verified by a second; COE by one reviewer, verified by consensus
- Included RCTs: vaginal estrogen (k = 22), nonestrogen hormones (k = 16), vaginal moisturizers (k = 4), multiple interventions (k = 4)
Pooled result
As reported in the abstract
- Vaginal estrogen vs placebo or no treatment may improve vulvovaginal dryness, dyspareunia, most bothersome symptom and treatment satisfaction
- Vaginal dehydroepiandrosterone (DHEA) vs placebo may improve dryness, dyspareunia, and distress, bother or interference from genitourinary symptoms
- Oral ospemifene vs placebo may improve dryness, dyspareunia and treatment satisfaction
- Vaginal moisturizers vs placebo may improve dryness
- Vaginal testosterone, systemic DHEA, vaginal oxytocin, and oral raloxifene or bazedoxifene may provide no benefit (low COE) or had uncertain effects (very low COE)
- Low COE
- Meta-analysis precluded by variation in populations, interventions, comparators and outcomes
Safety
- Studies did not report frequent serious harms; short-duration studies insufficiently powered to evaluate infrequent serious harms
Original publication
Hormonal Treatments and Vaginal Moisturizers for Genitourinary Syndrome of Menopause : A Systematic Review. Ann Intern Med. Published 10 September 2024. doi:10.
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