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Assessment of Vaginal Atrophy: a Review UvA-DARE (Digital Academic Repository) Effects of vaginal prolapse surgery and ageing on vaginal vascularization Weber, M.A. Publication date 2016 Document Version Final published version Link to publication Citation for published version (APA): Weber, M. A. (2016). Effects of vaginal prolapse surgery and ageing on vaginal vascularization. General rights It is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulations If you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: https://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. UvA-DARE is a service provided by the library of the University of Amsterdam (https://dare.uva.nl) Download date:03 Oct 2021 CHAPTER 5 _____________________________________ Assessment of vaginal atrophy: a review Weber MA, Limpens J, Roovers JP Int Urogynecol J. 2015 Jan;26(1):15-28 503427-L-sub01-bw-Weber ABSTRACT INTRODUCTION Introduction and hypothesis: The aim of this study is to provide an evidence-based Vaginal atrophy (VA) is a condition that commonly affects postmenopausal women (1;2). definition of vaginal atrophy (VA) and present an overview of subjective and objective Consensus on the most accepted definition of VA is lacking. measurements of VA applicable in clinical practice and research. It is estimated that up to 40% of postmenopausal women experience symptoms of VA (1- Search Methods: A systematic literature search was performed in MEDLINE and EMBASE 3). As life expectancy in many countries will further increase and exceeds 80 years, to identify studies reporting on measurement properties of diagnostic instruments for VA. women can experience a postmenopausal state up to one third of their lives having a Additional searches in MEDLINE aimed to document the definitions, diagnostic criteria, marked impact on, e.g., sexual functioning, everyday activities, and body image (2;4). and outcome measures of VA. Studies reporting on definitions, diagnosis, outcome The aetiology of VA is mainly explained by the decline in levels of circulating estrogen measurements, and measurement properties of diagnostic instruments of VA were associated with the natural aging process and the menopausal transition, which causes a selected. breakdown of the collagen and elastin fibers in the vagina (1;5-7). The result is an overall Results: Specific symptoms for VA that were consistently described could be identified to loss of vaginal elasticity, the vagina loses its rugae, and there is a shortening and suggest an evidence-based definition of VA. As subjective outcome measurements, seven narrowing of the vagina. The epithelium of the vagina becomes thin and pale (5). scoring systems to assess the signs of VA during physical examination were identified. The In premenopausal women, declining estrogen levels are iatrogenic, either related to Most Bothersome Symptom (MBS) approach is most useful in clinical practice and cancer treatment (radiation therapy, chemotherapy), drug use (antiestrogen medications, research as it focuses on the most common symptoms of VA. As objective outcome e.g., tamoxifen), surgery (oophorectomy), or postpartum due to the loss of placental measurements, numerous ways to assess vaginal cytology and vaginal pH were identified. estrogen and the antagonistic action of prolactin on estrogen production during lactation Conclusion: At the moment, there is no consensus on the definition and assessment of (1). VA. We propose to define VA as a common manifestation of estrogen decline associated Characteristics to objectify the presence of VA are either subjective (like symptoms with specific symptoms of which the most common are: vaginal dryness, itching or presented by the patient or the clinical judgement by the practitioner) or objective (like irritation and dyspareunia. In both clinical and research settings, subjective assessment histological or physiological tests). (the MBS approach) and objective assessments of VA (measurement of vaginal Concerning subjective measures to quantify VA, there is a problem related to maturation index and vaginal pH) should be combined. definition and the variety of measurement tools. In 2003, the US Food and Drug Administration (FDA) published a draft guidance for the conduct of clinical studies for the treatment of VA (8). Three years later, the FDA published a separate, more comprehensive guidance developed and used to document symptomatic improvement among study participants, also defined as the patient-reported most bothersome symptom (MBS) approach (9). Concerning objective tests the problems are related to the reproducibility of these tests and their correlation with symptoms and severity of VA. Due to the lack of consensus on the quantification of VA, comparisons between interventions are 84 503427-L-sub01-bw-Weber Assessment of vaginal atrophy ABSTRACT INTRODUCTION Introduction and hypothesis: The aim of this study is to provide an evidence-based Vaginal atrophy (VA) is a condition that commonly affects postmenopausal women (1;2). definition of vaginal atrophy (VA) and present an overview of subjective and objective Consensus on the most accepted definition of VA is lacking. measurements of VA applicable in clinical practice and research. It is estimated that up to 40% of postmenopausal women experience symptoms of VA (1- Search Methods: A systematic literature search was performed in MEDLINE and EMBASE 3). As life expectancy in many countries will further increase and exceeds 80 years, to identify studies reporting on measurement properties of diagnostic instruments for VA. women can experience a postmenopausal state up to one third of their lives having a Additional searches in MEDLINE aimed to document the definitions, diagnostic criteria, marked impact on, e.g., sexual functioning, everyday activities, and body image (2;4). and outcome measures of VA. Studies reporting on definitions, diagnosis, outcome The aetiology of VA is mainly explained by the decline in levels of circulating estrogen measurements, and measurement properties of diagnostic instruments of VA were associated with the natural aging process and the menopausal transition, which causes a selected. breakdown of the collagen and elastin fibers in the vagina (1;5-7). The result is an overall Results: Specific symptoms for VA that were consistently described could be identified to loss of vaginal elasticity, the vagina loses its rugae, and there is a shortening and suggest an evidence-based definition of VA. As subjective outcome measurements, seven narrowing of the vagina. The epithelium of the vagina becomes thin and pale (5). scoring systems to assess the signs of VA during physical examination were identified. The In premenopausal women, declining estrogen levels are iatrogenic, either related to Most Bothersome Symptom (MBS) approach is most useful in clinical practice and cancer treatment (radiation therapy, chemotherapy), drug use (antiestrogen medications, research as it focuses on the most common symptoms of VA. As objective outcome e.g., tamoxifen), surgery (oophorectomy), or postpartum due to the loss of placental 05 measurements, numerous ways to assess vaginal cytology and vaginal pH were identified. estrogen and the antagonistic action of prolactin on estrogen production during lactation Conclusion: At the moment, there is no consensus on the definition and assessment of (1). VA. We propose to define VA as a common manifestation of estrogen decline associated Characteristics to objectify the presence of VA are either subjective (like symptoms with specific symptoms of which the most common are: vaginal dryness, itching or presented by the patient or the clinical judgement by the practitioner) or objective (like irritation and dyspareunia. In both clinical and research settings, subjective assessment histological or physiological tests). (the MBS approach) and objective assessments of VA (measurement of vaginal Concerning subjective measures to quantify VA, there is a problem related to maturation index and vaginal pH) should be combined. definition and the variety of measurement tools. In 2003, the US Food and Drug Administration (FDA) published a draft guidance for the conduct of clinical studies for the treatment of VA (8). Three years later, the FDA published a separate, more comprehensive guidance developed and used to document symptomatic improvement among study participants, also defined as the patient-reported most bothersome symptom (MBS) approach (9). Concerning objective tests the problems are related to the reproducibility of these tests and their correlation with symptoms and severity of VA. Due to the lack of consensus on the quantification of VA, comparisons between interventions are 85 503427-L-sub01-bw-Weber Chapter 5 compromised and patient guidance in choosing the preferred treatment option might be Study selection inadequate. A study was included if it was an original article concerning VA. Studies reporting on In this review we provide
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