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The burden of vulvovaginal atrophy on women's daily living

implications on quality of life from a face-to-face real-life survey

Nappi, Rossella E., MD, PhD1; Palacios, Santiago, MD, PhD2; Bruyniks, Nico, MD, MRCOG, MFSRH3; Particco, Martire, MD4; Panay, Nick, BSc, FRCOG, MFSRH5 on behalf of the EVES Study investigators

doi: 10.1097/GME.0000000000001260
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Objective: This subanalysis of the European Vulvovaginal Epidemiology Survey study aimed to assess the correlation of vulvovaginal atrophy (VVA) symptoms and severity, when confirmed by objective gynecologic examination, with the quality of life of postmenopausal women.

Methods: Women aged 45 to 75 years with confirmation of last menstrual period more than 12 months before, who attended menopause or gynecology centers, were included. Those women had at least one VVA symptom filled in a group of questionnaires, including EuroQol-EQ-5D-3L and Day-to-Day Impact of Vaginal Aging (DIVA). To confirm the VVA diagnosis, an objective gynecologic examination was also performed.

Results: Of a total of 2,160 evaluable women, 66.3%, 30.5%, and 11.2% suffered from severe vaginal, vulvar, and urinary symptoms, respectively. VVA was confirmed in more than 90% of the participants. Mean (±SD) EQ-5D-3L score was 0.892 ± 0.144 and mean (±SD) score on the associated visual analog scale was 71.7 ± 16.0. Mean (±SD) DIVA score was 0.922 ± 0.653. For both EQ-5D-3L and DIVA, the overall scores and most of the dimensions/components were statistically significantly worse for women with severe VVA symptoms (vulvar and urinary) compared with women not affected by severe symptoms. Quality of life questionnaires showed worse scores in women where the diagnosis of VVA was confirmed by gynecologic examination.

Conclusions: Severe VVA symptoms showed a direct association with worse quality of life in postmenopausal women. This important effect on the quality of life of many women should be recognized as equivalent to those from other conditions and pathologies of which there is greater awareness.

1Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, University of Pavia, Pavia, Italy

2Palacios Institute of Women's Health, Madrid, Spain

3BrInPhar Ltd, Iver Heath, United Kingdom

4Shionogi Ltd, London, United Kingdom

5Imperial College London, London, United Kingdom.

Address correspondence to: Rossella E. Nappi, MD, PhD, Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, University of Pavia, Piazzale Golgi 2, 27100 Pavia, Italy. E-mail: renappi@tin.it

Received 7 June, 2018

Accepted 10 September, 2018

Funding/support: None.

Financial disclosure/conflicts of interest: RE has financial relationships (as a lecturer, member of advisory boards, and/or consultant) with Bayer-Schering Pharma, Endoceutics, Exceltis, Gedeon-Richter, HRA Pharma, Merck Sharp & Dohme, Novo Nordisk, Pfizer Inc., Shionogi Limited, and Teva Women's Health Inc/Theramex. SP has financial relationships (as a lecturer, member of advisory boards, and/or consultant) with Pfizer, Servier, Amgen, MSD, Preglem, Gynea, Sandoz, Procare Health, Bayer, MSD, Serelys, and Shionogi. He has also been a symposium speaker or advisory board member and has received research grants and/or consulting fees from Servier, Pfizer, GSK, Abbott, Ferrer, Bioiberica, Shionogi, Amgen, Novo Nordisk, Teva, Bayer Healthcare, Serelys, and Gedeon Richter. NB is an advisor for Shionogi Ltd. MP is an employee of Shionogi Ltd. NP has received honoraria for lecturing and acting in an advisory capacity for a number of pharma companies, including Abbott, Bayer, Besins, Mithra, MSD, Mylan, Novo Nordisk, Pfizer, SeCur, and Shionogi.

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© 2019 by The North American Menopause Society.