Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, Minnesota (K.E.U., C.S., N.Z., M.A., A.L., N.G.).
Center for Care Delivery and Outcomes Research, VA Health Care System, and Department of Medicine, University of Minnesota, Minneapolis, Minnesota (S.D., E.R.D.).
Ann Intern Med. 2024 Oct;177(10):1389-1399. doi: 10.7326/ANNALS-24-00603. Epub 2024 Sep 10.
Women seeking nonhormonal interventions for vulvovaginal, urinary, and sexual symptoms associated with genitourinary syndrome of menopause (GSM) may seek out complementary and alternative medicine or therapies (CAMs).
To summarize published evidence of CAMs for GSM.
Ovid MEDLINE, EMBASE, and CINAHL from inception through 11 December 2023.
Randomized controlled trials (RCTs) 8 weeks or more in duration that evaluated the effectiveness or harms of CAMs for postmenopausal women with GSM and reported 1 or more outcomes of interest, with sample sizes of 20 or more participants randomly assigned per group.
Data were abstracted by 1 reviewer and verified by a second.
An evidence map approach was used to organize and describe trials. Studies were organized by type of intervention, with narrative summaries for population, study characteristics, interventions, and outcomes. Fifty-seven trials were identified that investigated 39 unique interventions. Studies were typically small ( < 200), and most were done in Iran ( = 24) or other parts of Asia ( = 9). Few trials evaluated similar combinations of populations, interventions, comparators, or outcomes. Most studies ( = 44) examined natural products (that is, herbal or botanical supplements and vitamins), whereas fewer reported on mind and body practices ( = 6) or educational programs ( = 7). Most studies reported 1 or 2 GSM symptoms, mainly sexual ( = 44) or vulvovaginal ( = 30). Tools used to measure outcomes varied widely. Most trials reported on adverse events ( = 33).
Only English-language studies were used. Effect estimates, risk of bias, and certainty of evidence were not assessed.
There is a large and heterogeneous literature of CAM interventions for GSM. Trials were small, and few were done in North America. Standardized population, intervention, comparator, and outcomes reporting in future RCTs are needed.
Agency for Healthcare Research and Quality and Patient-Centered Outcomes Research Institute. (PROSPERO: CRD42023400684).
寻求非激素干预措施来缓解与女性生殖泌尿系统综合征（GSM）相关的外阴阴道、尿失禁和性功能障碍症状的女性，可能会寻求补充和替代医学或疗法（CAMs）。
总结已发表的关于 CAMs 治疗 GSM 的证据。
通过 Ovid MEDLINE、EMBASE 和 CINAHL 从建库至 2023 年 12 月 11 日进行检索。
评估 CAMs 对患有 GSM 的绝经后女性有效性或安全性的、持续时间至少 8 周的随机对照试验（RCTs），且报告了 1 个或更多感兴趣的结局，每组样本量至少为 20 名随机分配的参与者。
由 1 名评审员进行数据提取，并由另 1 名评审员进行验证。
采用证据图谱方法来组织和描述试验。研究按照干预类型进行组织，针对人群、研究特征、干预措施和结局进行叙述性总结。共确定了 57 项研究，涉及 39 种不同的干预措施。研究通常规模较小（ < 200 人），其中大多数来自伊朗（=24）或亚洲其他地区（=9）。很少有试验评估了类似的人群、干预措施、对照或结局组合。大多数研究（=44）评估了天然产品（即草药或植物补充剂和维生素），而报告心理和身体实践（=6）或教育计划（=7）的研究较少。大多数研究报告了 1 个或 2 个 GSM 症状，主要是性功能障碍（=44）或外阴阴道症状（=30）。用于测量结局的工具差异很大。大多数试验报告了不良事件（=33）。
仅使用了英语研究。未评估效应估计值、偏倚风险和证据确定性。
关于 GSM 的 CAM 干预措施有大量且异质性较大的文献。试验规模较小，且北美地区开展的试验较少。未来的 RCT 需要标准化人群、干预措施、对照和结局报告。
美国卫生保健研究与质量局和患者导向的结果研究所。（PROSPERO：CRD42023400684）。
