From the Journals

Popular vaginal dryness products don’t beat placebos

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For vaginal dryness relief, less may be more

The double-negative finding of the study suggests a potential change in clinical practice as to the value of estrogen for postmenopausal women, Alison J. Huang, MD, and Deborah Grady, MD, wrote in an editorial.

“Based on the results of this study, women and their physicians may want to take this one step further and conclude that postmenopausal women experiencing vulvovaginal symptoms should choose the cheapest moisturizer or lubricant available over the counter – at least until new evidence arises to suggest that there is any benefit to doing otherwise,” they said. The study compared popular active treatments – an estradiol tablet and a nonhormonal moisturizing gel – with placebo and not with each other, which could be considered a limitation, they said. However, the similar effectiveness of the treatments to placebo support a choice of treatments for vulvovaginal symptoms based on cost and patient preference for a particular formulation, they noted (JAMA Intern Med. 2018 Mar. doi: 10.1001/jamainternmed.2018.0094).

Dr. Huang and Dr. Grady are affiliated with the University of California, San Francisco, and the San Francisco Veterans Affairs Health Care System. Dr. Huang disclosed research grants from Pfizer and Astellas Pharma. Dr. Grady has served as a consultant to MenoGeniX.


 

FROM JAMA INTERNAL MEDICINE

Estrogen tablets and a popular vaginal gel failed to top placebo for relieving vulvovaginal symptoms in postmenopausal women, based on data from a randomized trial of more than 300 patients suffering from genitourinary syndrome of menopause (GSM), a constellation of symptoms including pain on vaginal penetration and vaginal dryness.

“Surveys of postmenopausal women demonstrate a preference for effective, nonhormonal therapies, often due to safety concerns,” wrote Caroline M. Mitchell, MD, of Massachusetts General Hospital, Boston, and her colleagues. The report was published in JAMA Internal Medicine. The researchers randomized 302 postmenopausal women with GSM 1:1:1 to a Vagifem 10-microgram estradiol tablet and placebo gel, a placebo tablet and Replens gel, or a placebo tablet and a placebo gel.

The average age of the women was 61 years, 88% were white, and 81% were sexually active.

The primary outcome was a decrease in the most bothersome symptoms reported by the women after 12 weeks of treatment. The most common of these were pain on penetration (60%) and vulvovaginal dryness (21%).

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