Imvaggis is indicated for the local treatment of vaginal symptoms of oestrogen deficiency in postmenopausal women.1
Vaginal Atrophy under-diagnosed
Menopause usually begins in women between the age of 45 and 55, but can occur before or after this age. In the UK the average age is 51.3 The change in oestrogen levels that takes place at menopause can cause both physical and emotional symptoms, it can also lead to a condition known as vaginal atrophy. 4-6 Vaginal atrophy is caused by a lack of oestrogen in the vaginal tissues, which occurs during the menopause.7 Vaginal atrophy can cause pain during sex as well as making it uncomfortable to sit, stand, exercise, urinate or even work. Vaginal atrophy can affect everyday life, whether women are sexually active or not. This can have a detrimental effect on quality of life.8 The prevalence of vaginal atrophy symptoms in postmenopausal women is over 50%.2 Of those who suffer from vaginal atrophy, a minority of around 25% will seek medical help.9
Before menopause vagina is well supplied with oestrogen. After menopause, when levels of oestrogen are low, the vaginal lining is thinner and has fewer folds, the vagina loses elasticity, shortens, narrows and becomes less distensible and more susceptible to trauma, due to Vaginal Atrophy (VA) (also referred to as Urogenital Atrophy or Vulvovaginal Atrophy (VVA)).11
As oestrogen receptors are present on the vagina, urethra, bladder trigone and the pelvic floor, all of these areas can be affected.12 In order to encompass all of these areas the North American Menopause Society (NAMS) and the International Society for the Study of Women’s Sexual Health (ISSWSH) have introduced the term Genitourinary Syndrome of Menopause (GSM).13
About Vaginal Atrophy
Adapted from Johnston S 2006 and Reiter S 2013.14,15
This diagram is an example of the lining of the vagina before menopause (left side of diagram) and after menopause (right side of diagram).
Guidelines and Recommendations
for Vaginal Atrophy
- NICE Guidance recommends offering vaginal oestrogen to women with vaginal atrophy6
- It is important that treatment is started early, if possible, to reduce any irreversible changes occurring12
- NICE guidance states that vaginal oestrogen can be continued for as long as needed to relieve symptoms6
- Treatment should be continued to maintain benefits, as symptoms of vaginal atrophy often come back when treatment with vaginal oestrogen is stopped6
- Women should then be reviewed annually1
1. Imvaggis (estriol) 0.03mg Summary of Product Characteristics. Available from https://www.medicines.org.uk/emc/product/10435/smpc Last accessed: October 2020. 2. Nappi RE, et al. Diagnosis and management of symptoms associated with vulvovaginal atrophy: expert opinion on behalf of the Italian VVA study group. Gynecol Endocrinol. 2016;32(8):602-606. 3. Women’s Health Concern (WHC). The Menopause. Available from https://www.womens-health-concern.org/help-and-advice/factsheets/menopause/ Last accessed: October 2020. 4. Mayo Clinic. Menopause. Symptoms and causes. Available from https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397 Last accessed: October 2020. 5. Mayo Clinic. Vaginal atrophy. Symptoms and causes. Available from https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Last accessed: October 2020. 6. National Institute for Health and Care Excellence. Clinical Knowledge Summaries. Managing Menopause. Available from https://cks.nice.org.uk/topics/menopause/management/managing-the-menopause/ Last accessed: October 2020. 7. Mac Bride MB, et al. Vulvovaginal atrophy. Mayo Clin Proc. 2010;85(1):87-94. 8. Women’s Health Concern (WHC). Vaginal dryness. Available from https://www.womens-health-concern.org/help-and-advice/factsheets/vaginal-dryness/ Last accessed: October 2020. 9. Sturdee DW, et al. International Menopause Society Writing Group. Recommendations for the management of postmenopausal vaginal atrophy. Climacteric. 2010;13(6):509-522. 10. Nappi RE, et al. Vaginal Health: Insights, Views & Attitudes (VIVA) – results from an international survey. Climacteric. 2012;15(1):36-44. 11. Johnston S. The Recognition and Management of Atrophic Vaginitis. Geriatrics & Aging. 2002;5(7):9-15. 12. Primary Care Women’s Health Forum. Guidance on Diagnosis and Management of Urogenital Atrophy or Genitourinary Syndrome of the Menopause (GSM). Available from https://pcwhf.co.uk/wp-content/uploads/2018/11/GSM-Guideline.pdf. Last accessed: October 2020. 13. Portman DJ, et al. Vulvovaginal Atrophy Terminology Consensus Conference panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Menopause 2014; 21: 1063-1068. 14. Johnston S. Urogenital Concerns. JOGC. 2006;28(2):S33-S42. 15. Reiter S. Barriers to effective treatment of vaginal atrophy with local estrogen therapy. Int J Gen Med. 2013;6:153-158.