Clinical profile of women with VVA who are not candidates for local vaginal oestrogen therapy

Vulvar and vaginal atrophy (VVA) is a chronic medical condition in postmenopausal women, which is predominantly due to a permanent cessation of ovarian oestrogen production. Current available treatment options for VVA are over-the-counter (OTC) symptomatic relief products or local oestrogen therapy (LET) aiming to treat this underlying atrophic condition. Recent surveys indicated that these products decrease sexual spontaneity, are messy and indiscrete. Ospemifene is an oral daily drug, which has proven to treat vaginal dryness and dyspareunia effectively. However, despite the comparable efficacy of ospemifene versus placebo to oestrogen versus placebo, ospemifene is currently indicated for women, who are not candidates for LET. It is up to the gynaecologist to make an appropriate therapeutic decision. There are potential candidates who have not been considered for ospemifene and yet would benefit from this treatment, such as breast cancer survivors, or patients unable to perform or that have problems performing vaginal insertion/application of oestrogen based treatments, such as women that suffer from prolapse. Likewise, a patient's concern for hormone treatment safety, treatment regimens complexity or cross contamination with their partner are potential issues to consider when prescribing treatment for VVA in order to provide the best therapeutic option for patients who are generally not compliant with their current therapy.