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An individualized approach to the management of vaginal atrophy in Latin America

Palacios, Santiago MD, PhD1; Nappi, Rossella E. MD, PhD2; Shapiro, Marla CM, MDCM, CCFP, MHSc, FRCPC, FCFP, NCMP3; de Melo, Nilson Roberto MD, PhD4; Wender, María Celeste Osorio MD, PhD5; Fernandes, César Eduardo MD, PhD6; Pardini, Dolores MD, PhD7; Machado, Rogério Bonassi MD, PhD8; Kulak, Jaime Jr MD, PhD9; Celis-González, Cuauhtémoc MD10; Martino, Mabel T. MD11; Pizzi, Rita R. MD12; Villaseca, Paulina MD13; Storch, Eduardo MD14; Danckers, Luis Fernando MD15; Hernández-Bueno, José Alberto MD16

doi: 10.1097/GME.0000000000001368
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Objective: In the absence of guidelines specific for Latin America, a region where the impact of menopause is becoming increasingly important, an evidence-based specialist opinion on management of vaginal atrophy will help improve outcomes.

Methods: An advisory board meeting was convened in São Paulo, Brazil, to discuss practical recommendations for managing vaginal atrophy in women in Latin America. Before the meeting, physicians considered various aspects of the condition, summarizing information accordingly. This information was discussed during the meeting. The expert consensus is now summarized.

Results: In Latin America, given the relatively early age of menopause, it will be beneficial to raise awareness of vaginal atrophy among women before they enter menopause, considering cultural attitudes and involving partners as appropriate. Women should be advised about lifestyle modifications, including attention to genital hygiene, clothing, and sexual activity, and encouraged to seek help as soon as they experience vaginal discomfort. Although treatment can be started at any time, prompt treatment is preferable. A range of treatments is available. By addressing the underlying pathology, local estrogen therapy can provide effective symptom relief, with choice of preparation guided by patient preference. An individualized treatment approach should be considered, giving attention to patients’ specific situations.

Conclusions: It is critical that women are empowered to understand vaginal atrophy. Educating women and healthcare providers to engage in open dialogue will facilitate appreciation of the benefits and means of maintaining urogenital health, helping to improve outcomes in middle age and beyond. Women should receive this education before menopause.

1Palacios Institute of Women's Health, Madrid, Spain

2Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy

3Department of Family and Community Medicine, University of Toronto, Ontario, Canada

4Department of Obstetrics and Gynecology, São Paulo University Medical School, São Paulo, Brazil

5Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Brazil

6Department of Obstetric and Gynecology, ABC Medical School, Santo André, São Paulo, Brazil

7Department of Endocrinology, Federal University of São Paulo, São Paulo, Brazil

8Department of Gynecology, Jundiaí Medical School, São Paulo, Brazil

9Department of Obstetrics & Gynecology, Federal University of Parana, Curitiba, Brazil

10Hospital de Ginecología y Obstetricia No.4 “Luis Castelazo Ayala,” Mexican Institute of Social Security, Mexico City, Mexico

11Asociacion de Obstetricia y Ginecologia de Rosario (ASOGIR), Rosario, Argentina (member of the Collaborative Group for Research of the Climacteric in Latin America [REDLINC])

12Department of Endocrinology, Universidad Central de Venezuela, Caracas, Venezuela

13Department of Endocrinology, Pontificia Universidad Católica de Chile, Santiago, Chile

14Sociedad Uruguaya de Ginecotocología, Sociedad Uruguaya de Endocrinología Ginecológica y Menopausia, Montevideo, Uruguay

15REDLINC, Peru

16Atención Medica Integral para la Mujer, S.C., Naucalpan, Mexico.

Address correspondence to: Santiago Palacios, MD, PhD, Instituto Palacios, Salud y Medicina de la Mujer, Calle de Antonio Acuña, 9, 28009 Madrid, Spain. E-mail: ipalacios@institutopalacios.com

Received 21 December, 2018

Revised 28 January, 2019

Accepted 28 January, 2019

Funding/support: The advisory board on which this article was based (Management of Vaginal Atrophy in Latin America), as well as the medical writing support for this manuscript, was funded by Novo Nordisk Health Care AG, Switzerland.

Financial disclosure/conflicts of interest: SP has a financial relationship (lecturer, member of advisory boards, and/or consultant) with Bayer Healthcare, Bioiberica, Ferrer, Gedeon Ritcher, GSK, Gynea, MSD, Novo Nordisk, Pfizer, Procare Health, Serelys, Servier, Shionogi, and Teva. REN has a financial relationship (lecturer, member of advisory boards, and/or consultant) with Bayer HealthCare, Endoceutics, Exceltis, Gedeon Richter, MSD, Novo Nordisk, Pfizer, Shionogi, Teva, and Zambon SpA. MS has a financial relationship (lecturer, member of advisory boards, and/or consultant) with Amgen, AMAG, Bayer, GSK, Merck, Mithra, Novo Nordisk and Pfizer, TherapeuticsMD, and Valeant. MCOW has a financial relationship (lecturer or member of advisory boards) with Bayer HealthCare, Novo Nordisk, Pfizer, Libbs, and Grunenthal. CEF has a financial relationship (lecturer or member of advisory boards) with Aché, Amgen, Bayer HealthCare, Pfizer, Libbs, Sanofi, and Grunenthal. DP declares no conflicts of interest. RBM has a financial relationship (lecturer or member of advisory boards) with Bayer, Besins, MSD, Novo Nordisk, Libbs, and Grunenthal. JKJr participated in the Novo Nordisk advisory board on which this article is based. PV has participated in the advisory board for Novo Nordisk. ES has participated in advisory boards for Novo Nordisk. LFD participated in the Management of Vaginal Atrophy advisory board on which this article is based. JAHB has a financial relationship (lecturer, advisory board/consultant) with Pfizer, MSD, Novartis, Servier, Exeltis, Grünenthal, Roche, Sanofi, GSK, Amgen, Eli Lilly, Novartis, Procaps, Besins Health Care, and Asofarma, and receives funding from Valdecasas Laboratories for travel to a congress. NRdM, CC-G, RRP, and MTM declare no conflicts of interest.

Authors’ contributions: All the authors participated in the advisory board, providing information on which this article is based, with the exception of JAH-B, who was unable to attend the meeting. All the authors are responsible for the content of the article, having critically reviewed the drafts of the manuscript and provided input to produce the final text, which everyone has approved.

Online date: June 10, 2019

© 2019 by The North American Menopause Society.