Ovarian Cancer and Vulvovaginal Atrophy Management

Relationship Between Ovarian Cancer and Vulvovaginal Atrophy

The National Comprehensive Cancer Network recommends that ovarian cancer treatments, including surgery, chemotherapy, radiation therapy, and hormone therapy, can lead to vulvovaginal atrophy in patients with ovarian cancer 1, 2
Surgical interventions for ovarian cancer, particularly bilateral oophorectomy, cause immediate estrogen deprivation leading to vulvovaginal atrophy in women with ovarian cancer 3, 4
Radiation therapy to the pelvic area can cause long-term complications including fibrosis, stenosis, and vulvovaginal atrophy in ovarian cancer patients 1, 2
Chemotherapy agents, especially alkylating agents, can induce ovarian failure resulting in decreased estrogen production and subsequent vulvovaginal atrophy in women with ovarian cancer 4
Hormone therapies that reduce estrogen levels contribute to vaginal dryness and atrophy in ovarian cancer patients 3

The American College of Obstetricians and Gynecologists notes that symptoms of vulvovaginal atrophy include vaginal dryness, discomfort, pruritis, dyspareunia, urinary tract infections, and urinary urgency in postmenopausal women with ovarian cancer 3, 5
Unlike vasomotor symptoms, vulvovaginal atrophy symptoms typically persist indefinitely and may worsen without treatment in ovarian cancer survivors 3, 5

The American Society of Clinical Oncology recommends regular use of vaginal moisturizers for daily comfort and water-based lubricants for sexual activity in ovarian cancer survivors with vulvovaginal atrophy 6, 5
Moisturizers may need to be applied at higher frequency in the vagina, at the vaginal opening, and on the external folds of the vulva in women with ovarian cancer 6
Vaginal dilators may benefit women with vaginismus and/or vaginal stenosis, particularly important for those treated with pelvic radiation therapy for ovarian cancer 6, 5
Pelvic floor physical therapy can help decrease anxiety, discomfort, and lower urinary tract symptoms in ovarian cancer survivors with vulvovaginal atrophy 6
Low-dose vaginal estrogen can be considered for women with persistent symptoms not responding to non-hormonal measures after a thorough discussion of risks and benefits, according to the National Comprehensive Cancer Network 6, 5
Vaginal dehydroepiandrosterone is an option for women who have not responded to previous treatments for vulvovaginal atrophy 6
Ospemifene may be offered to postmenopausal women without current or history of hormone-sensitive cancer, as recommended by the American College of Obstetricians and Gynecologists 6, 5

The National Comprehensive Cancer Network strongly recommends postradiation use of vaginal dilators and moisturizers to prevent stenosis and maintain vaginal health in ovarian cancer patients 1, 2
All patients, whether sexually active or not, should be asked about genitourinary symptoms, including vulvovaginal dryness, according to the American Society of Clinical Oncology 1, 2
For treatment-related menopause, hormone therapy should be considered if not contraindicated, as recommended by the National Comprehensive Cancer Network 1
Patients should be referred to appropriate specialty providers based on symptoms and needs, according to the American Society of Clinical Oncology 1, 2