Management of Vaginal Atrophy After Bilateral Oophorectomy

Introduction to Vaginal Atrophy

Vaginal atrophy after bilateral oophorectomy is treatable at any stage, and treatment should be initiated regardless of how long symptoms have been present, as these symptoms persist indefinitely without intervention and significantly impair quality of life, according to the American Society of Clinical Oncology 1, 2

Over 90% of women experience severe and long-lasting menopausal symptoms including vaginal atrophy after bilateral oophorectomy, because the surgery eliminates even the small amount of residual estrogen that postmenopausal ovaries produce, leading to an acute estrogen deprivation state 1, 3
The number of women affected by atrophic vaginitis increases over time rather than decreases, making treatment essential at any point, as stated by the American College of Obstetricians and Gynecologists 1

The American College of Obstetricians and Gynecologists recommends starting with vaginal moisturizers for daily comfort and water-based lubricants for sexual activity as first-line non-hormonal approaches 4
Pelvic floor physical therapy can be considered to address pelvic floor dysfunction, which can decrease anxiety, discomfort, and lower urinary tract symptoms, according to the Journal of Clinical Oncology 5, 4
Vaginal dehydroepiandrosterone (DHEA) is an option for women who have not responded to previous treatments, as suggested by the Praxis Medical Insights 4

Systemic hormone replacement therapy should be strongly considered for women who underwent bilateral oophorectomy and remain symptomatic despite local vaginal therapy, to prevent accelerated bone loss, cardiovascular disease, and cognitive decline, according to the Praxis Medical Insights 3
17-β estradiol is preferred over conjugated equine estrogens, and transdermal estradiol is preferred, particularly in women with cardiovascular risk factors, as recommended by the Praxis Medical Insights 3

Sexual dysfunction affects at least 50% of women after bilateral oophorectomy and requires specific evaluation of desire, arousal, lubrication, orgasm, satisfaction, and pain using validated instruments, according to the Journal of Clinical Oncology 5, 6, 2
Annual assessment of sexual function, vaginal atrophy symptoms, and bone health is recommended, as stated by the Praxis Medical Insights 3