a Department of Family and Community Medicine , University of Toronto , Toronto , ON , Canada.
Climacteric. 2019 Feb;22(1):38-43. doi: 10.1080/13697137.2018.1527306. Epub 2018 Nov 19.
Genitourinary syndrome of menopause including vulvovaginal atrophy is commonly experienced by postmenopausal women, reducing their quality of life. The aim of this review is to assess current treatment options within the framework of recent management guidelines. Recommendations include use of treatments addressing both symptoms and the underlying pathophysiology, and proactive patient discussion. Both prescription and non-prescription options are recognized, including non-hormone-based approaches. Local therapy is preferable in the primary treatment of genitourinary syndrome of menopause symptoms as risk of adverse events is reduced, although long-term safety data are limited. Management of patients with a history of breast cancer requires careful consideration, although estrogen therapy has not been associated with increased risk of breast cancer or of recurrence. Treatment should consider ongoing cancer therapy. As multiple, comparable options exist, treatment choice may be due to experience and patient preference. Best management requires effective patient-physician communication and shared decision-making.
绝经后妇女普遍经历泌尿生殖系统综合征，包括阴道萎缩，降低了她们的生活质量。本综述的目的是在最近的管理指南框架内评估当前的治疗选择。建议包括使用针对症状和潜在病理生理学的治疗方法，并积极与患者进行讨论。既认可处方和非处方选择，也认可非激素方法。局部治疗是治疗绝经后泌尿生殖系统综合征症状的首选方法，因为不良反应风险降低，尽管长期安全性数据有限。对于有乳腺癌病史的患者，管理需要仔细考虑，尽管雌激素治疗与增加乳腺癌风险或复发风险无关。治疗应考虑正在进行的癌症治疗。由于存在多种类似的选择，因此治疗选择可能取决于经验和患者偏好。最佳管理需要有效的医患沟通和共同决策。
