A Review of Pharmacological Treatments for Vaginal Atrophy in Postmenopausal Women in Iran.

Vaginal atrophy is one of the most common menopausal complications and is often overlooked. There are various pharmacological and non-pharmacological treatment approaches to reduce vaginal atrophy; however, no comprehensive study on a convenient, affordable, inexpensive, and noninvasive treatment with fewer complications has been conducted so far. Thus, the current study aimed to provide a systematic review of pharmacological treatment for vaginal atrophy in postmenopausal women in Iran. In this systematic review, all Iranian articles published in Persian or English during 2009 to 2019 were collected and analyzed by searching the Scopus, PubMed, Web of Science, Magiran, Iranian Registry of Clinical Trials (IRCT), and Cochrane Library databases. The inclusion criteria were clinical trials for vaginal atrophy and menopause. Based on the selection criteria, articles with a Jadad scale score of 3 and above were included in the study and qualitatively analyzed. Overall, 15 clinical trials met the inclusion criteria. In total, 12 articles examined the efficacy of pharmacological treatments (including three herbal medicines, three vitamins and dietary supplements, and two chemical drugs) in treating vaginal atrophy in postmenopausal women. Various types of medication have been used to improve vaginal atrophy, and effective treatments include licorice, chamomile, royal jelly, vitamin E, vitamin D, hyaluronic acid, and Vagifem; however, the results of studies on fennel have been inconsistent. However, considering the small number of studies reviewed, further studies with a stronger methodology are needed to confirm the efficacy of these medications.

An overview of the phytoestrogen effect on vaginal health and dyspareunia in peri- and post-menopausal women.

OBJECTIVE: The aim of this overview was to evaluate the effectiveness of phytoestrogens on vaginal health and dyspareunia in peri- and post-menopausal women. MATERIAL AND METHODS: Three databases including MEDLINE, Scopus and the Cochrane Central Register of Controlled Trials were from inception to August 2017. RESULT: Two systematic reviews and 11 RCTs were included in the overview. According to the findings, isoflavones increased the maturation value and attenuated the vaginal atrophy in the post-menopausal women. Topical isoflavones had beneficial effects on the vaginal atrophy. Similar efficacy was found in Pueraria mirifica and conjugated estrogen cream on dryness ( p = 0.277), soreness ( p = 0.124) and irritation ( p = 0.469), as well as discharge ( p = 0.225) and dyspareunia ( p = 0.089). However, the conjugated estrogen cream was more effective compared to Pueraria mirifica ( p > 0.005) regarding maturation index improvement. Comparison of fennel 5% vaginal cream and placebo gel showed significant difference in superficial cells ( p < 0.01), parabasal cells ( p < 0.01) and intermediate cells ( p < 0.01), whereas no difference was found between the oral fennel and placebo in terms of superficial, parabasal and intermediate cells as well as Maturation value. Administration of 80 mg red clover oil had a significant effect on superficial ( p < 0.005), intermediate ( p < 0.005) and parabasal and vaginal dryness ( p < 0.005) compared to the placebo. Flaxseed had also a trivial effect on maturation value. Genistein had a more prominent effect on the genital score. The severity of dyspareunia decreased by 27%. CONCLUSION: Phytoestrogens have various effects based on administration route and type on the vaginal atrophy.

Obstacles to the discussion of sexual problems in menopausal women: a qualitative study of healthcare providers.

The aim of this study was to explore issues that challenge menopausal women in discussions of their sexual problems with a physician. This was done from the perspective of healthcare providers. In a descriptive exploratory qualitative study, using a semi-structured interview and purposive sampling, a sample set of 12 midwives and 13 general practitioners aged 25-70 years were selected in order to elicit meaning behind their experiences about the subject under study. Data analysis was carried out using qualitative content analysis. Results were used to identify a number of obstacles that hindered women from seeking help for sexual problems from GPs and midwives. These obstacles included the following: (1) traditional and cultural beliefs; (2) religious belief; (3) individuals' beliefs and (4) access to services. More research is needed to explore effective strategies to overcome these problems. Impact statement Current knowledge on the subject: In the literature, many reasons have been identified for the unwillingness of Iranian women to discuss their sexual problems with health providers. These include lack of time, feelings of shame and an expectation that a doctor cannot help. However, no qualitative study has addressed barriers held by menopausal women for seeking treatment for sexual problems. The contribution made by the results of this study: The results of this study add to the growing body of research on reasons that determine why most postmenopausal women rarely visit a doctor unless they were in tremendous physical or emotional pain. Also, menopausal women thought that an unmarried health provider would be less understanding about sexual and marital problems and they felt guilty about sharing such issues with them. Patients' opinions on the nature of menopause (a pathological vs. physiological process) affect the way in which the symptoms of menopause and sexual problems are handled by patient. The implications are of these findings for clinical practice and further research: The results of this study can be used to formulate guidelines to cultural sensitivity appropriate to Iranian society.

Effects of Phytoestrogens in Alleviating the Menopausal Symptoms: A Systematic Review and Meta-Analysis.

The aim of this study was to perform a meta-analysis of high-quality, randomized, controlled trials (RCTs), to investigate the effectiveness of phytoestrogens in alleviating the menopausal symptoms (vaginal atrophy). Variety of databases including PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CCRCT) were searched up to May 2015 according to the below-mentioned pre-specified search strategy and using the relevant MeSH terms. The mean difference was applied as an estimate of the main effect size. Moreover, due to the considerable heterogeneity among studies, the random-effects model was used to obtain the pooled effect size derived from primary studies. Results showed that while the standardized mean difference of vaginal cell maturation index was increased up to 0.164 percent (with the confidence interval at 95%: (-0.419-0.746), but this increase was not statistically significant (P=0.582). The absence of the publication bias was confirmed using the Egger's regression intercept test (P = 0.24). Also, meta-analysis of soybeans studies showed that while the standardized mean difference of vaginal maturation index increased 0.072% in (95% CI: -0.42 to 0.5.), this increase was not statistically significant (p = 0.777). The results confirm that soybeans and phytoestrogens have non-significant positive effects on the vaginal atrophy index. Hence, it is suggested that with regard to non-significant positive effects, non-hormonal treatments along with other treatments such as the vaginal gels and so on should be used more in cases with non-severe vaginal atrophy.