Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics & Gynecology, University of Texas at San Antonio, San Antonio, the Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics & Gynecology, University of Texas Southwestern Medical Center, Dallas, and the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, Texas; the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, Michigan; the Division of Urogynecology, ProHealth Women's Services, Waukesha Memorial Hospital, Waukesha, Wisconsin; the Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island; the Departments of Obstetrics and Gynecology and Urology, MedStar Washington Hospital Center, Georgetown University School of Medicine, and the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, Howard University College of Medicine, Washington, DC; and the Salinas Valley Memorial Healthcare System, Salinas, California.
Obstet Gynecol. 2023 Sep 1;142(3):555-570. doi: 10.1097/AOG.0000000000005288. Epub 2023 Aug 4.
To systematically review the literature and provide clinical practice guidelines regarding various nonestrogen therapies for treatment of genitourinary syndrome of menopause (GSM).
MEDLINE, EMBASE, ClinicalTrials.gov , and Cochrane databases were searched from inception to July 2021. We included comparative and noncomparative studies. Interventions and comparators were limited to seven products that are commercially available and currently in use (vaginal dehydroepiandrosterone [DHEA], ospemifene, laser or energy-based therapies, polycarbophil-based vaginal moisturizer, Tibolone, vaginal hyaluronic acid, testosterone). Topical estrogen, placebo, other nonestrogen products, as well as no treatment were considered as comparators.
We double-screened 9,131 abstracts and identified 136 studies that met our criteria. Studies were assessed for quality and strength of evidence by the systematic review group.
TABULATION, INTEGRATION, AND RESULTS: Information regarding the participants, details on the intervention and comparator and outcomes were extracted from the eligible studies. Alternative therapies were similar or superior to estrogen or placebo with minimal increase in adverse events. Dose response was noted with vaginal DHEA and testosterone. Vaginal DHEA, ospemifene, erbium and fractional carbon dioxide (CO 2 ) laser, polycarbophil-based vaginal moisturizer, tibolone, hyaluronic acid, and testosterone all improved subjective and objective signs of atrophy. Vaginal DHEA, ospemifene, tibolone, fractional CO 2 laser, polycarbophil-based vaginal moisturizer, and testosterone improved sexual function.
Most nonestrogen therapies are effective treatments for the various symptoms of GSM. There are insufficient data to compare nonestrogen options to each other.
系统回顾文献，为治疗女性生殖泌尿综合征（GSM）的各种非雌激素治疗方法提供临床实践指南。
从建库至 2021 年 7 月，我们在 MEDLINE、EMBASE、ClinicalTrials.gov 和 Cochrane 数据库中进行了检索。我们纳入了比较和非比较研究。干预措施和对照限于七种商业上可获得且目前正在使用的产品（阴道脱氢表雄酮[DHEA]、奥昔孕肽、激光或基于能量的疗法、多库酯阴道保湿剂、替勃龙、阴道透明质酸、睾酮）。局部雌激素、安慰剂、其他非雌激素产品以及未治疗被视为对照。
我们对 9131 篇摘要进行了双屏幕筛选，并确定了符合我们标准的 136 项研究。系统评价组评估了研究的质量和证据强度。
表格、整合和结果：从合格研究中提取了有关参与者、干预和对照以及结局的信息。替代疗法与雌激素或安慰剂相似或更优，不良反应增加最小。阴道 DHEA 和睾酮均观察到剂量反应。阴道 DHEA、奥昔孕肽、铒和二氧化碳（CO 2 ）激光、多库酯阴道保湿剂、替勃龙、透明质酸和睾酮均可改善萎缩的主观和客观体征。阴道 DHEA、奥昔孕肽、替勃龙、CO 2 激光、多库酯阴道保湿剂和睾酮均改善了性功能。
大多数非雌激素疗法是治疗 GSM 各种症状的有效治疗方法。没有足够的数据将非雌激素选择相互比较。
