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Invited Commentary
May 2018

Rethinking the Approach to Managing Postmenopausal Vulvovaginal Symptoms

Author Affiliations
  • 1Department of Medicine, University of California, San Francisco
  • 2San Francisco Veterans Affairs Health Care System, San Francisco, California
JAMA Intern Med. 2018;178(5):690-691. doi:10.1001/jamainternmed.2018.0094

In this issue of JAMA Internal Medicine, Mitchell et al1 present the results of a randomized, double-blind, placebo-controlled, multisite trial of 2 existing, widely used treatments for postmenopausal vulvovaginal atrophy symptoms—a low-dose prescription vaginal estradiol tablet (Vagifem) and an over-the-counter nonhormonal vaginal moisturizing gel (Replens). Participants were postmenopausal women who rated the severity of their vulvovaginal symptoms including itching, pain, dryness, irritation, and pain with vaginal intercourse on a standardized scale. Consistent with US Food and Drug Administration guidance, the investigators examined change in severity of participants’ “most bothersome symptom” over 4 and 12 weeks as the primary outcome, along with a variety of secondary symptom-based outcomes and tissue-specific markers of vulvovaginal atrophy.

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