Experience with ospemifene in patients with vulvovaginal atrophy treated with laser therapy: case studies

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Abstract

Vaginal laser therapy is a non-hormonal treatment option for vulvovaginal atrophy (VVA), a component of the genitourinary syndrome of menopause. Through a microablative and/ or thermal effect on atrophic vaginal epithelium, laser therapy activates growth factors that increase vascularity and collagen production. Laser and ospemifene are complementary treatments: the laser’s effects on intra- and extracellular water are supported by the activity of ospemifene at estrogen receptors to restore vaginal epithelium and natural lubrication. This article reports the clinical course of two women with dyspareunia preventing sexual intercourse who were treated with ospemifene and laser therapy. The woman in case 1 had extreme vaginal stenosis and severe VVA symptoms. CO2 laser therapy accompanied by estriol vaginal gel and vaginal moisturizer was unsuccessful. After ospemifene and three sessions of laser therapy, followed by vaginal ring resection and continued physiotherapy-directed mechanical dilation of the vagina, she was asymptomatic within 6 months. The woman in case 2 had severe VVA, which had prevented penetration for 2 years. Ospemifene was administered for 1 month to prepare the vaginal epithelium for photothermal therapy. A single erbium:YAG laser session and continued ospemifene treatment improved her symptoms sufficiently to allow her to resume sexual relations within 2 months.

Keywords: laser therapy, ospemifene, vulvar and vaginal atrophy.

Citation: Lugo Salcedo F, Estrada Blanco Z. Experience with ospemifene in patients with vulvovaginal atrophy treated with laser therapy: case studies. Drugs in Context 2020; 9: 2020-3-7. DOI: 10.7573/dic.2020-3-7

Contributions: All authors contributed equally to the preparation of this case report. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: Dr. Lugo Salcedo reports personal fees from Shionogi, outside the submitted work. Dr. Estrada Blanco reports personal fees from Shionogi, outside the submitted work.The authors have also provided scientific support to Shionogi Spain by lecturing and/or taking part in Advisory Board meetings organized by Shionogi (Madrid, Spain). The authors’ time was compensated by Shionogi Spain according to local codes of practice. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2020/06/dic.2020-3-7-COI.pdf

Acknowledgements: Medical writing assistance was provided by Jon Monk and Kerry Dechant on behalf of Content Ed Net (Madrid, Spain). This article forms part of a Special Issue. All authors contributed to developing this Special Issue by sharing their experience with the benefit of patients in mind. The publication is expected to benefit gynecologists in their daily clinical practice by increasing knowledge and expertise.

Funding declaration: Medical writing assistance was funded by Shionogi (Madrid, Spain). This article forms part of a Special Issue funded by Shionogi (Madrid, Spain).

Copyright: Copyright © 2020 Lugo Salcedo F, Estrada Blanco Z. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2020 Lugo Salcedo F, Estrada Blanco Z. https://doi.org/10.7573/dic.2020-3-7. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/experience-with-ospemifene-in-patients-with-vulvovaginal-atrophy-treated-with-laser-therapy:-case-studies/

Correspondence: Félix Lugo Salcedo, Gynecology Service, Women’s Carmona Dexeus, Via Augusta, 285, 08017 Barcelona, Spain. felizlugoucv@gmail.com

Provenance: submitted; externally peer reviewed.

Submitted: 20 March 2020; Peer review comments to author: 20 April 2020; Revised manuscript received: 20 May 2020; Accepted: 21 May 2020; Publication date: 1 July 2020.

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