Management of post-menopausal vaginal atrophy and atrophic vaginitis.

The involution of the female genital tract seems to reflect a built-in biological life expectancy, inter-related with the hypothalamic-hypophyseal-ovarian axis. Lower levels of oestradiol have a number of adverse effects, including on the lower urinary tract. The major universal change is vaginal atrophy. The vaginal mucosa becomes thinner and dry, which can produce vaginal discomfort, dryness, burning, itching, and dyspareunia. The vaginal epithelium may become inflamed, contributing to urinary symptoms such as frequency, urgency, dysuria, incontinence, and/or recurrent infections. Moreover, it has been suggested that reduced oestrogen levels may affect periurethral tissues and contribute to pelvic laxity and stress incontinence. In association with hypoestrogenemia, changes in vaginal pH and vaginal flora may predispose post-menopausal women to urinary tract infection. Treatment to date has been based on local hormonal therapy, in the form of vaginal creams, tablets or suppositories. Other routes of hormone administration have also proved to be successful. Both local and systemic administration are both effective in maturation of the vaginal epithelium. However, despite the fact that the benefits of oestrogen replacement in preventing vaginal atrophy and reducing the incidence of related symptoms are well established, such therapy is contraindicated in some women and is not an acceptable option for others. Furthermore, the optimal HT administration route, the dosage regimen, and non-hormonal alternatives for improving symptoms and quality of life of the post-menopausal female population, have not been well studied. This review focuses on the changes involved in vaginal aging and efforts to present a synopsis of the pathophysiology and therapy of atrophic vaginitis and vaginal atrophy.

Spanish Menopause Society position statement: Use of denosumab in postmenopausal women.

Denosumab is a new drug developed for the treatment of osteoporosis. Moreover, increasing evidences link denosumab with benefits in cancer, an area of interest for those in charge of the postmenopausal health. Denosumab has shown efficacy in the control of bone loss associated with hypogonadic states created by chemotherapy in breast and other cancers. Moreover, some studies reveal efficacy in reducing the progression of metastases. A panel of experts from the Spanish Menopause Society has met to develop usage recommendations based on the best available evidence.

2013 Up-date of the consensus statement of the Spanish Menopause Society on postmenopausal osteoporosis.

Postmenopausal osteoporosis is a major female health problem that increases morbidity, mortality and healthcare system costs. Considering that gynecologists are the primary health practitioners involved in the treatment of women with osteoporosis in our country, a panel of experts from the Spanish Menopause Society met to establish a set of criteria and procedures for the diagnosis and treatment of this disease based on the best available evidence and according to the model proposed by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system to elaborate clinical practice guidelines and to classify the quality of the evidence and the strength of the recommendations. These recommendations should be a reference to gynecologist and other health professionals involved in the treatment of postmenopausal women.

Reduction of urinary levels of N-telopeptide correlates with treatment compliance in women with postmenopausal osteoporosis receiving alendronate.

OBJECTIVE: The aim of this study was to assess the factors associated with the effectiveness of treatment with alendronate (ALN) quantified by a reduction in urinary excretion of N-telopeptide (NTx). METHODS: The study is an observational, prospective, multicenter trial, with a 6-month follow-up. Postmenopausal osteoporotic women (densitometric criteria), who initiated treatment with ALN (70 mg/weekly) without previous treatment with antiresorptive agents (12 month) and calcitonin (6 month), were included. The assessment of NTx levels (nmol bone collagen equivalents/mmol creatinine) in the urine was performed at baseline and after completion of follow-up. A logistic regression model included "achieving a reduction in urinary NTx of at least 30% (minimal clinically significant change [MCSC])" as a dichotomous dependent variable and the following as independent variables: baseline urinary NTx levels, treatment compliance, years since diagnosis of menopause, ALN treatment duration, and treatment with calcium and vitamin D. Treatment compliance was assessed as the percentage of days of medication prescribed as a function of the time between the beginning and end of treatment. Good compliance was defined as a percentage between 80% and 120%. RESULTS: The variables that reached statistical significance were baseline urinary NTx values (odds ratio, 1.052; 95% CI, 1.025-1.079) and compliance (odds ratio, 3.9; 95% CI, 1.5-10.1). Therefore, the women with good treatment compliance were almost 4 times more likely to achieve an MCSC in NTx levels, and the raise in one unit of urinary NTx baseline values increased by 5% of the probability of achieving MCSC. CONCLUSIONS: Treatment with ALN (70 mg/week) in women with postmenopausal osteoporosis effectively reduces the urinary excretion of the bone turnover biomarker NTx. The probability of achieving a clinically significant reduction is greater in those women with higher baseline levels of NTx and in women who comply with treatment.

Effects on serum lipid and leptin levels of three different doses of norethisterone continuously combined with a fixed dose of 17beta-estradiol for nasal administration in postmenopausal women: a controlled, double-blind study.

OBJECTIVE: To evaluate the effect of intranasal continuous combined hormone therapy on serum lipids and leptin levels in healthy postmenopausal women. DESIGN: Multicenter, double-blind, double-dummy, randomized, controlled study conducted in parallel groups. SETTING: Outpatient clinics of three Spanish hospitals and two private health centers. PATIENT(S): A total of 333 healthy postmenopausal women aged 40 to 75 years. INTERVENTION(S): Women were randomly allocated to either one of three different doses of norethisterone (50 microg/day, 175 microg/day, or 550 microg/day) continuously combined with a fixed dose of 17beta-estradiol (350 microg/day) for nasal administration, or 17beta-estradiol at 2 mg/day combined with oral norethisterone acetate at 1 mg/day. MAIN OUTCOME MEASURE(S): Serum lipid, glucose, and leptin levels were assessed at baseline and after 12, 24, 36, and 52 weeks of treatment. RESULT(S): Overweight women (body mass index >25 kg/m(2)) had higher baseline leptin levels, but these levels increased in all groups across the study unrelated to body mass index. Both intranasal and oral therapy had the effect of increasing the levels of leptin after 24 weeks in healthy postmenopausal women. As expected, total cholesterol and low-density lipoprotein cholesterol levels decreased and high-density lipoprotein levels increased in the four groups. CONCLUSION(S): Body mass index is a strong determinant of serum leptin levels in healthy postmenopausal women; serum leptin increased in all the hormone therapy regimes.