J Menopausal Med.  2018 Apr;24(1):1-10. 10.6118/jmm.2018.24.1.1.

Therapeutic Approaches to Atrophic Vaginitis in Postmenopausal Women: A Systematic Review with a Network Meta-analysis of Randomized Controlled Trials

• Lee A
• Kim TH
• Lee HH
• Kim YS
• Enkhbold T
• Lee B
• Park YJ
• Song K

• KMID: 2429214
• DOI: http://doi.org/10.6118/jmm.2018.24.1.1

Abstract

OBJECTIVES
Atrophic vaginitis (AV), which is common in postmenopausal women, is characterized by vaginal dryness, dyspareunia, and discomfort. There are a variety of therapeutic agents for the treatment of AV, besides hormone replacement therapy. We performed this systematic review to compare the effectiveness of various therapies for symptom improvement in AV patients.
METHODS
We searched the Cochrane Library, EMBASE, MEDLINE, and other literature (Google Scholar, Web of Science, and hand search) for studies published between January 2010 and March 2015. AV was evaluated by the following outcomes: vaginal pH, dyspareunia, vaginal dryness, or cytological change (endometrial thickness, percentages of superficial cells and parabasal cells). They measured treatment efficacy with various outcomes pertaining to AV symptoms.
RESULTS
Meta-analysis suggested that ospemifene was effective against dyspareunia, vaginal dryness, endometrial thickness, and percentage changes in superficial and parabasal cells. Vaginal pH was most affected by soy isoflavone vaginal gel. Ospemifene was effective for AV symptoms.
CONCLUSIONS
This systematic review compared the effects of several therapeutic agents on symptoms of AV through a network meta-analysis. This study provides objective evidence for clinical treatment and efficacy management in AV.

Keyword

Atrophic vaginitis; Network meta-analysis; Postmenopause; Therapeutics; Vagina

MeSH Terms

Atrophic Vaginitis*
Dyspareunia
Female
Hand
Hormone Replacement Therapy
Humans
Hydrogen-Ion Concentration
Postmenopause
Treatment Outcome
Vagina
Vaginal Creams, Foams, and Jellies
Vaginal Creams, Foams, and Jellies

Figure

• 

  Fig. 1 Flowchart diagram of the search procedure and inclusion of studies into the review.

• 

  Fig. 2 The size of the nodes corresponds to the number of trials that study the treatments. Directly comparable treatments are linked with a line, the thickness of which corresponds to the number of trials that assess the comparison. PBO: placebo, BZA: bazedoxifene, CE: conjugated estrogens, EST: estriol vaginal gel, OSP: ospemifene, SBO: sea buckthorn oil, SIF: soy isoflavone vaginal gel.

• 

  Fig. 3 Forest plots for effect sizes of treatments for the outcomes. BZA: bazedoxifene, CrI: credible intervals.

• 

  Fig. 4 Rank probability analysis for each outcome. SMD: standardized mean difference.

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