Blog RSS

vittlesThere have been only 2 randomized clinical trials addressing whether or not vitamin and mineral supplements are effective for the prevention of cardiovascular disease. One of these, the Physicians’ Health Study II did not find an association between the use of a multivitamin-mineral (MVM) supplement and cardiovascular disease (CVD) in either incidence or mortality after an average of 11 years, in male U S physicians 50 years or older. The other study, the French Supplementation en Vitamines et Mineraux Antioxydants, randomly assigned women and men (women 35-60 y.o.; men 45-60 y.o.) to receive either the daily antioxidant combination (not an MVM – vitamin C, alpha tocopherol, beta carotene, selenium and zinc) or placebo and after 7.5 years CVD incidence was not statistically different between the two arms. In 2010, a large Swedish cohort study of women found that multi vitamins,(MV) without minerals, were associated with a reduced risk of myocardial infarction, and if they used them greater than 5 years, the association was even stronger.

The current study set out to examine the association between MVN and MV use and CVD mortality in US adults who did not previously have CVD. The researchers linked the NHANES II data and the 2011 National Death Index to examine the association between MVM and MV use and mortality due to CVD. These two large surveys provide data on over 10,000 adults 40 years and older. Data points included history of myocardial infarction, stroke, coronary heart disease, cardiovascular disease, non skin cancers, diabetes, alcohol, smoking, height, weight, blood pressure, cholesterol, triglyceride, glucose/glycolated hemoglobin testing, age, race, education, dietary supplements (vitamins, minerals, herbs) , and over the counter and prescription medications. A MVM was defined as 3 or more vitamins and at least 1 mineral. A MV was a vitamin combination without minerals. There were also 3 duration categories of < 1 year, 1-3 years and > 3 years.

Approximately 45% of the individuals evaluated had used a dietary supplement in the previous 30 days. MVMs were the most frequently used (21%) and MVs 14 %.

Results: Neither MVM nor MV use was associated with a lower risk of CVD mortality when they compared users with nonusers. However, when they looked at the length of time of use, there was indeed a significant inverse association for MVM use of > 3 years with a more than 35% reduced risk of CVD mortality in women, but not men. MV only, was not significantly associated with CVD mortality when combining men and women, although men only who had used MV for 1-3 years did have reduced CVD related mortality.

Commentary: It’s reassuring to see some positive data for MVM users and prescribers, and useful to see that longer use, in this case > 3 years is clearly associated with reduced mortality from cardiovascular disease. All kinds of critiques can be lodged against this kind of study, since it is not the gold standard randomized controlled trial. However, even RCT can be criticized because they are often of short duration and have a more homogeneous population of individuals being studied. The current study is strong in the robust diversity of individuals as well as a large sample that were older than 65, which is especially useful when looking at cardiovascular disease mortality.

There are many research studies on individual minerals, vitamins, amino acids, fish oils and herbs that show efficacy in both prevention and intervention in different areas of cardiovascular disease. Examples include magnesium intake and an inverse association with risk of strokes, reduced risk of ischemic heart disease and CVD mortality; protective CV effect of vitamin D; Hawthorne to improve outcomes of congestive heart failure; the many and diverse cardiovascular benefits in prevention and treatment for fish oils (strokes, CVD mortality, blood pressure, type 2 diabetes and more).

As a result of the current study, I will be more eager to recommend long term use of MVM for women in my practice and in my teachings.

Reference

Bailey R, Fakhouri T, Park Y, et al. Multivitamin-mineral use is associated with reduced risk of cardiovascular disease mortality among women in the United States. J Nutrition 2015 doi:10,3945/jn.114.204743

military ptsdData on post-traumatic stress disorder (PTSD) in women military personnel was evaluated at the Veterans Administration to determine the association between PTSD within 1 year of delivery and risk or a history of a prior diagnosis of PTSD and the risk of preterm birth.

In more than 16,000 deliveries, 19% were in women with PTSD including 12% with active PTSD. The risk for spontaneous preterm delivery was higher among women with active PTSD (9%) than those with a history of PTSD (8%) or those with no PTSD (7%). The majority of the women with active PTSD had experienced sexual trauma while in the military as well as depression disorders.

In a separate study of prenatal stress, researchers randomized 64, low income, pregnant urban black women who entered the study at 16-21 weeks of their pregnancy to receive either a supplement of 450 mg of docosahexaenoic acid (DHA) or placebo until their delivery. At 30 weeks gestation, those who were in the DHA group had a lower perception of stress than those in the placebo group. Those who received DHA also had lower cortisol output in response to arriving at the research facility and a better ability to modulate their response to a social stress test.

Commentary: I have to say that the aspect of these two studies that was the most striking was the high prevalence of sexual trauma experienced by women while in the military. Moving beyond that, both of these studies highlight the important impact of maternal stress and maternal well-being on birth outcomes. This study also highlights the potential of DHA in improving the maternal response to stress during pregnancy, yet one more reason for the importance of supplementing with fish oil during pregnancy. Clinicians should also conclude the importance of inquiring about traumatic experiences past and present and employ strategies to help manage trauma and stress.

References

Shaw J, et al. Posttraumatic stress disorder and risk of spontaneous preterm birth. Obstet Gynecol 2014 Dec ;124:1111

Keenan K, et al. Association between fatty acid supplementation and prenatal stress in African Americans. A randomized controlled trial. Obstet Gunecol 2014 Dec; 124:1080

An Italian study at a fertility center conducted a study to assess in vitro fertilization (IVF) outcomes in women who were of normal body weight, of reproductive and with adequate ovarian follicles. Women with a vitamin D serum level < 20 ng/mL (considered deficient) were compared with those having > 20 ng/mL (optimal levels = 20-40 ng/mL). Artificial insemination

Of the 335 women who participated, 154 had a serum vitamin D level < 20 ng/mL and 181 had levels of > 20 ng/mL. Women with higher serum levels had more high quality embryos even though a similar number of eggs and embryos were transferred. Women with higher serum levels of vitamin D also had a higher pregnancy rate of 31% vs. 20%. Women with a serum vitamin D level > 30 ng/mL had the greatest chances of pregnancy.

Commentary: What appears obvious to me is that women should have their serum vitamin D level tested prior to undergoing the arduous process of IVF. If their levels are < 20 ng/mL, it would seem logical to dose with vitamin D to improve serum levels, and retest in 3 months to assure > 20 ng/mL before proceeding. While this study does not prove a causal predictive relationship between serum vitamin D levels and IVF success of pregnancy it does seem plausible and worth the simple approach of assuring adequate vitamin D levels in women seeking pregnancy, especially in those seeking IVF.

Reference

Ref. Paffoni A, et al. Vitamin D deficiency and infertility: Insights from in vitro fertilization cycles. J Clin Endocrinol Metab 2014; Aug 14 (e-pub ahead of print)

The diagnosis of polycystic ovary syndrome (PCOS) has been through many permutations in the last 30 years I have been in practice. The most widely used and accepted current definition of PCOS is from the consensus criteria from 2003, called the Rotterdam Criteria. The diagnostic criteria for the Rotterdam diagnosis of PCOS require the presence of two of the following:

 

1. oligomenorrhea/anovulation-as manifested by a cycle length of > 35 days

2. hyperandrogenism: indicated by hirsutism or male pattern baldness, or elevated serum androgen levels (testosterone, androstenedione or dehydroepiandrosterone) clinical

3. polycystic ovaries on ultrasound ( > 12 small follicles in an ovary)

Other etiologies must be excluded such as congenital adrenal hyperplasia, androgen secreting tumors, Cushing syndrome, thyroid dysfunction and hyperprolactinemia

The first step in the diagnosis is to determine if both hirsutism and oligomenorrhea are present based on a medical history and physical exam. If both these issues are present, then an ultrasound is not necessary and a diagnosis of PCOS is likely and treatment can begin, because approximately 95% of women with hirsutism and oligomenorrhea have multifollicular ovaries on a pelvic ultrasound.

If only one or the other, hirsutism or oligomenorrhea, is present, the additional tests need to be done. If hirsutism is the singular presenting symptom (without oligomenorrhea or amenorrhea), then a pelvic ultrasound should be ordered. If there are then 12 or more small follicles, i.e. multifollicular ovaries then a diagnosis of PCOS can be stated. If oligomenorrhea is the only symptom with no hirsutism, then it is recommended that serum androgens be ordered as well as a pelvic ultrasound. If there are elevated serum androgens and/or a multifollicular ovary are found, then a diagnosis of PCOS is concluded.

Women with amenorrhea should have other tests after a comprehensive medical history and physical exam, including serum prolactin, thyroid stimulating hormone, and after a comprehensive history and physical exam- a progesterone challenge test. Other tests may also include follicle stimulating hormone. Amenorrhea in women who have a history of at least one previous menses, has numerous causes and PCOS is just one of them. Others include hypothyroid, prolactin secreting tumors, stress, premature menopause, and something called hypothalamic amenorrhea (ex/ eating disorder). Women with PCOS who are overweight or obese, should have additional testing including those for prediabetes, type 2 diabetes, and hyperlipidemia.

PCOS is a complex endocrinological disorder and women should seek care from a clinician who is well versed in underlying causes, the multiple body systems it affects, and optimally uses an integrative medicine approach utilizing the benefits of nutrition, exercise, herbal and nutrient supplements and selected pharmaceutical prescriptions as needed.

Please see other blog postings for PCOS treatments utilizing natural therapies including green tea, N-acetyl cysteine and more.

Sources:

1. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004;81:19–25

2. Legro R, et al. Diagnosis and treatment of polycystic ovary syndrome: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2013 Dec; 98:4565

The perception of dry mouth (known as xerostomia) affects up to 40% of adults in the U.S. and can have a significant effect on quality of life. Causes can include medications, diabetes, Sjogren syndrome and hormonal changes such as menopause. Previous animal and laboratory studies provided evidence that green tea polyphenols could be beneficial for xerostomia.

The current human study used a double-blind, placebo-controlled, randomized design comparing green tea to xylitol. The study involved 60 individuals (58 green tea powderwomen and 2 men) with the complaint of dry mouth and had Sjogren syndrome mediated salivary gland hypofunction, with 30 taking the placebo and 30 taking the green tea medicine. The green tea proprietary formula contained green tea catechins and other ingredients (amounts not given; but internet search reveals the following information: Xylitol, Sorbitol, Natural Flavors, Green Tea (Leaf), Acadia Gum, Jaborandi Extract (Leaf), Magnesium Stearate, Silicon Dioxide, Sucralose). The placebo contained 500 mg xylitol and other non-plant ingredients. Participants took 1 lozenge every 4 hours for a maximum of 6 lozenges per day, over an 8 week period. Quality of life assessments and saliva collection with volume determined were used to evaluate response.

After 8 weeks of therapy, the xylitol-containing placebo failed to affect saliva output while the green tea catechin containing formulated resulted in a statistically significant increase in saliva output with a 3.8 fold increase in unstimulated saliva output and a 2.1 fold increase in stimulated saliva output, compared with baseline. This occurred within 1 week. Both groups experienced a quality of life scored demonstrating significant improvement with no significant difference between groups.

Commentary: Most commercial products for xerostomia contain xylitol although it has not been known if xylitol does in fact play a role in saliva output. A xylitol chewing gum, a sorbitol containing lozenge and a xylitol containing spray previously showed no efficacy in stimulating saliva in patients with xerostomia. Other research using a maltose-containing lozenge found a potential benefit for xerostomia and another with a 1% malic acid spray did show a modest increase in salivary flow rates. It is not clear why there is a discrepancy between salivary output-increase in the treatment medication compared to placebo vs. the similar effects on subjective quality of life measures. A longer study with more participants would hope to clarify and produce greater results in the treatment group not only in objective measures of salivary output but also in subjective quality of life values.

Reference

De Rossi S, Thoppay J, Dickinson D, et al. A phase Ii clinical trial of a natural formulation containing tea catechins for xerostomia. Oral Surg Oral Med Oral Pathol Oral Radiol 2014;118:447-454.

black cohosh, freshThis randomized, double-blind, placebo-controlled clinical trial was conducted in Iran with a total of 84 postmenopausal women. Women were randomly assigned to one black cohosh tablet per day (n=42) or one placebo (n=42) per day for 8 weeks. The severity of vasomotor symptoms and number of hot flashes were recorded in the pre-treatment phase and 4 and 8 weeks after intervention. In Iran, black cohosh is supplied by Goldaru Pharmaceutical Company under the name of Cimifugol and each tablet contains 6.5 mg of dried extract of black cohosh root, equal to 0.12 to 0.18 mg of 27 deoxy ectoine.

Participants were postmenopausal women ages 45 to 60 years old were included in the study if no menses for 12 consecutive months, normal blood pressure, a minimum score of 2 for vasomotor symptom severity; no history of breast or cervical cancer, liver disease, abnormal postmenopausal bleeding, depression or hyperthyroidism and no psychiatric medications or hormones or herbs used for treating menopausal symptoms. In addition, no smoking and no alcohol use were also inclusion criteria.

The primary outcome was the effect of black cohosh or placebo on vasomotor symptoms severity, using the FDA and Green climacteric vasomotor scale for both hot flashes and night sweats. For daytime hot flashes, a score of 1 = mild, without sweating. A score of 2 = average sensation of heat with sweating but no interruption of daily task functions. A score of 3 = severe, extra intense sensation of heat and sweating with dysfunction and interruption of daily tasks. For night sweats, 1= mild and they do not wake the woman up and only wake up if they realize they are sweating; 2 = average, they wake up due to heat and sweating but no change of clothing or sheets is needed; 3= severe and they wake up due to heat and sweating and do need to change their cloths or get out of bed or open windows. A minimum Green vasomotor score is 1 and the maximum is 6. There was a considerable decline in vasomotor symptom severity and number of hot flashes after 4 weeks and 8 weeks in particular, compared with placebo.

Commentary: Vasomotor symptoms are seen in approximately 75% of perimenopausal and postmenopausal women and can last from 1-10 years and even more than 10 years for some women. Hot flashes can not only be very uncomfortable if moderate to severe, they can make many women anxious, self-conscious in their work environment and can significantly interfere with sleep resulting in fatigue, poor cognitive function and labile moods. Treating the vasomotor symptoms successfully can improve and potentially even alleviate all these issues. This is not the first study where I’ve run into these very low doses of extracts of an herb, and it is difficult comparing them to products in the U.S.

Reference

Shahnazi M, Nahaee J, Moammad-Alizadeh-Charandabi S, Bayatipayan S. Effects of black cohosh on vasomotor symptoms in postmenopausal women: A randomized clinical trial. J Caring Sciences 2013;2(2):105-113

Menstrual cramps are one of most common menstrual related problems that women face. Non-steroidal anti-inflammatory (NSAIDS) are the most common self-treatment that women use, but they don’t always work adequately or at all, and some women have side effects from them. I have written previous blogs on natural solutions for menstrual cramps, including ginger and valerian. This double-blind, randomized, placebo-controlled trial investigated the use of fenugreek seed powder during menses, in women with moderate to severe menstrual cramps.fenugreek seeds

Iranian women of similar age, body mass index (BMI) and pain level of menstrual cramps were enrolled in this study and given either ground fenugreek seed capsules at 900 mg three times per day or placebo for the first 3 days of menses and for two consecutive menstrual cycles. If the woman felt she needed pain medication, she was instructed to take this 1 hour or more after consumption of the study medicine/placebo.

Patients reported additional medications used for pain, pain severity, and any other menstruation symptoms. A visual analog scale (VAS) was used to assess pain during the first 3 days of menstruation in addition to the time of day the pain was most prominent. A score of 1-2 indicated mild pain, 3-7 was moderate, and 8-10 was severe.

A total of 106 patients were enrolled and 101 completed the study. There were 51 in the fenugreek group and 50 in the placebo group. At study entry, there were no significant differences in age, age of menstruation, menstrual pain, pain severity, or BMI. At the end of the study, the severity of pain significantly decreased in both groups after the second menstrual cycle as compared to baseline (fenugreek group=3.25 vs. 6.4, placebo group=5.96 vs. 6.14). After each cycle, pain severity in the fenugreek group was significantly less as compared to placebo (cycle 1=4.32 vs. 6.03, and cycle 2=3.25 vs. 5.96). The duration of pain was significantly decreased in the fenugreek group and the average use of pain medication in the fenugreek group significantly decreased by the end of the study compared to the placebo group.

Commentary: The results of this study point to a meaningful response of fenugreek seed powder compared to baseline at 900 mg three times daily the first 3 days of menses for women with moderate to severe menstrual cramps. The use of fenugreek was more effective than placebo in reducing severity of pain, duration of pain and a decrease in the use of pain medications. This approach to moderate to severe menstrual cramps is easy and safe to try as an alternative treatment for menstrual cramps.

Reference

Younesy S, Amiraliakbari S, Esmaeili S, Alavimajd H, Nouraei S. Effects of fenugreek seed on the severity and systemic symptoms of dysmenorrhea. J Reprod Infertil. January 2014;15(1):41-48.

The Effects of chaste tree berry (Vitex agnus castus) extract and magnesium on fracture healing in women with long bone fractures.

The purpose of this study was to investigate the effects of chaste tree with and without magnesium on the healing of long bone fractures in young women.

In this double-blind randomized placebo-controlled clinical trial, 64 women ages 20 to 45 y.o. with a traumatic (injury) long bone fracture (upper arm=humerus, bone fractureforearm= radius or ulna, upper leg=femur or lower leg=tibia), were enrolled. All of these patients were treated with surgery for their fracture. The patients were randomized to one of four groups: either the chaste tree (1 tablet containing 4 mg of a dried fruit extract), plus placebo, or the chaste tree extract plus magnesium oxide 250 mg/day or magnesium plus placebo or placebo plus placebo daily, for 8 weeks. A questionnaire was given at the beginning of the study that included age, fracture cause, any history of a previous fracture as well as anatomical location of that fracture. They were also categorized into 3 groups according to the amount of physical activity they usually did= light (household tasks, riding in a car, light activity while sitting), moderate (walking 3-5 km/h, light sport, occasional gardening or husbandry), or severe (rigorous sports, agriculture or husbandry).

Nutritional intake was evaluated by a food frequency questionnaire. Blood tests were taken including alkaline phosphatase, osteocalcin, and vascular endothelial factor (VEGF), plus standard X-ray, all at the beginning and after 8 weeks.

Sixty four patients entered the study and 51 completed it. The 14 patients were excluded due to not taking the supplements adequately or lack of returning for follow-up. The starting fracture rates were distributed in 52.9% in the tibia, 25.5% in the femur, 13.7% in the humerus and 7.8% in the radius and ulna. A total of 21.6% had a previous history of fractures.

Comparison of the average differences of alkaline phosphatase levels at the beginning and end of the treatment intervention was not statistically significant between the four groups. The only group in which there was any increase in alkaline phosphatase was in the chaste tree only group. There was a difference in the average value of osteocalcin between the groups. The increased osteocalcin level in the chaste tree and magnesium group was significant compared to the chaste tree alone or placebo alone. There were no significant differences in the average values of VEGF variation in the study groups although again, the chaste tree only group did have some increase. Most importantly, x-ray evidence of the percentage of callus formation at the site of the fracture (a sign of healing), was most significant in the chaste tree and magnesium group (80%), then the chaste tree 71.4%), magnesium alone (50.0%) and placebo (53.8%).

These results suggest that administration of chaste tree plus magnesium may promote fracture healing in premenopausal women with long bone fractures of the arm or leg.

Comments: This study is a new and innovative idea for the treatment of long bone fractures in young women, especially in the realm of using chaste tree for this purpose. It deserves pointing out that the group of women studied was not postmenopausal women let alone not postmenopausal women with low bone density or outright osteoporosis. It would be important not to extrapolate the results to those women, although I would find no harm in adding chaste tree and magnesium to enhance healing of fractures in those women.

In summary, the combination use of chaste tree and magnesium may synergistically improve fracture healing by increased osteocalcin and VEGF levels and callous formation, even for just 8 weeks.

Reference

Eftekhari M, Rostami Z, Emami M, Tabatabaee H. Effects of vitex agnus castus extract and magnesium supplementation, alone and in combination, on osteogenic and angiogenic factors and fracture healing in women with long bone fracture. J Res Med Sci. 2014;19(1):1-7

The most common perimenopause and menopause symptoms are vasomotor symptoms, aka hot flashes and/or night sweats. In addition to numerous perimenopause/menopause symptoms, postmenopausal women in particular, are at increased risk for cardiovascular disease, dyslipidemia, hypertension and type 2 diabetes. Plant compounds such as French maritime pine bark extract (Pycnogenol) are rich in proanthocyanidins and have been studied in 3 studies to alleviate menopause symptoms such as vasomotor symptoms. Because of grape seeds on white background macro closeupthese 3 studies, and an analysis showing that grape seeds are even richer in proanthocyanidins, researchers have conducted and published a study examining the effects of grape seed proanthocyanidin extract on menopause symptoms, body composition and cardiovascular markers.

A randomized, double-blind, placebo-controlled study was conducted in almost 100 premenopause, perimenopause and postmenopause middle-aged women between 40 and 60 y.o. The average age was 49-59 years with 40% to 48% premenopausal women, 52% to 60% perimenopausal, postmenopausal or were surgically menopausal. Women were randomized to receive grape seed extract tablets that contained either 100 mg per day or 200 mg/day of proanthocyanidins or placebo for a total of 8 weeks. Menopause symptoms were evaluated using the Menopausal Health-Related Quality of Life Questionnaire, the Hospital Anxiety and Depression Scale and the Athens Insomnia Scale before the start of treatment as well as after 4 weeks and 8 weeks of treatment.

Significant changes were observed in hot flashes, anxiety, insomnia, increased muscle mass and reduced blood pressure. The average physical symptom score for the nine items in the physical health domain of the Menopause Health Related Questionnaire significantly improved in the high dose grape seed extract group after 8 weeks, as did the mean score for hot flashes. The mean depression score did not improve in any of the groups but the anxiety subscale score improved in both the 100 mg and 200 mg group and was significantly better in the higher dose group than in the placebo. Mean body weight and fat mass did not change in any of the groups, but the mean lean mass and muscle mass increased significantly in both the 100 mg and 200 mg grape seed extract groups. Lastly, the mean systolic and diastolic blood pressure was significantly reduced in both the 100 mg and 200 mg groups and after as short as 4 weeks. The mean systolic and diastolic blood pressure decreased by about 5 mm Hg with both doses after 8 weeks.

Commentary: The menopause studies using pine bark demonstrated positive results in improving menopause symptoms at all three different doses studied in each of the studies, 60 mg, 100 mg and 200 mg. Similarly in the current study, the two doses of grape seed extract, 100 mg and 200 mg, both worked well for hot flashes, although the 200 mg dose was clearly better than the 100 mg dose in the anxiety subscale. This study appears to be the first report of proanthocyanidins affecting body composition, increasing muscle mass with both doses. The positive effect on blood pressure using proanthocyanidins, including those in grape seed extract is not a new finding. I have been using pine bark extract for vasomotor symptoms in perimenopause and menopause women for the past several years, with mixed results. I am intrigued by the current study and look forward to using grape seed extract in these two doses, as another non hormonal option, especially in women who need not only vasomotor symptom relief, but are struggling with overweight and pre-hypertension or stage I hypertension.

Reference

Terauchi M, Horiguchi N, Kajiyama A, et al. Effects of grape seed proanthocyanidin extract on menopausal symptoms, body composition, and cardiovascular parameters in middle-aged women: a randomized, double-blind, placebo-controlled pilot study. Menopause 2014;21(9):990-996.

Most practitioners of women’s health are familiar with the terms vulvovaginal atrophy and atrophic vaginitis. Many women with this condition, also are familiar with these terms. However, they can be quite inadequate and not precise enough for describing the actual physical changes that are occurring and the symptoms that result from these changes that occur with the vulva, vagina and/or lower urinary tract that is associated with lowering of the body’s natural production of estrogen. The term vulvovaginal atrophy describes what the postmenopausal vulva looks like but doesn’t describe the associated symptoms. The term atrophic vaginitis implies inflammation or even infection, even though neither of these is the primary aspect of atrophic changes of the vulva and/or vagina.

I know that I always feel quite impolite and sound somewhat rude or at least insensitive, when I use the term vulvovaginal atrophy or atrophic vulvovaginitis with my patients. I think it imparts an excessive aging image, when these changes are in fact within the realm of normal. Neither of the current terms properly addresses the changes in the lower urinary tract. Other previous urogenital terminology changes have been useful, in both men and women… examples include overactive bladder (in place of urge incontinence, and erectile dysfunction instead of impotence).

Recognizing these issues, the board of directors of the International Society for the Study of Women’s Sexual Health (ISSWSH) and the North American Menopause Society (NAMS) cosponsored a terminology consensus conference in May of 2013. Experts in the field were selected and the relevant scientific literature was reviewed. Participants were then separated into 3 groups to determine a more descriptive, comprehensive and accurate terminology for practitioners, patients and the media. Each of the 3 groups then proposed terms to the entire consensus group for discussion and assessment. Through this process, potentially acceptable terms were voted on. The final two choices were further discussed and then a consensus was met. The process and consensus results were presented at the 2 scientific meetings of ISSWSH (February 2014) and NAMS (October 2013). The boards of both organizations then approved the new term, genitourinary syndrome of menopause (GSM).

female anatomyGSM is now defined as a collection of symptoms and signs associated with a decrease in estrogen and other sex steroids involving the changes to the labia majora/minora, clitoris, vestibule/introitus, vagina, urethra and bladder. These physical signs may include anatomic changes (ex/ thinning of the vulvar and/or vaginal tissue, a thin and smaller labia majora, a narrowed introitus- vaginal opening). The physiological changes result in reduced vaginal blood flow, diminished lubrication, decreased elasticity of the vaginal wall, an increased vaginal pH and decreased vaginal flora with loss of lactobacilli. The syndrome can include, but is not exclusively limited to genital symptoms of dryness, burning and irritation, fissuring of vulvar tissue, and bleeding after sex; sexual symptoms of decreased lubrication, discomfort or pain with vulvovaginal touch/penetration, and impaired arousal/orgasm functions; and urinary symptoms of urgency, dysuria and recurrent urinary tract infections. Women with GSM can present with some or even all of the signs and symptoms which must be bothersome to indicate the diagnosis and without some other diagnosis that accounts for the symptoms.

A full description of the process, new terminology and comprehensive description is found in the paper cited in the citation for this column below.

Reference

Portman D, Gass M. and consensus 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. : 1063-1068

« Prev - Next »