Home' Australian Pharmacist : Australian Pharmacist July 2014 Contents Australian Pharmacist July 2014 I ©Pharmaceutical Society of Australia Ltd.
1. Choose the CORRECT statement
about vulvovaginal atrophy.
a) Sexual activity tends to exacerbate
b) It is characterised by vaginal dryness
c) Symptoms are self-limiting and tend to
resolve over time.
d) The prevalence decreases with
2. Which of the following is associated
with vulvovaginal atrophy?
a) History of breast cancer.
b) Hypothalamic amenorrhoea.
d) All of the above.
3. A decline in circulating oestrogen
levels is associated with which of the
following pathophysiologic changes
in the vagina?
a) Reduction in vaginal alkalinity.
b) Increased vaginal fluid secretions and
c) Thinning of the vaginal epithelium
d) Increase in vaginal elasticity and rugal
4. Choose the CORRECT statement
about the management of
a) Vaginal oestrogens are no more
effective than systemic oestrogen
treatments for symptomatic
b) Non-hormonal preparations and
continued sexual activity are
recommended as first-line treatment.
c) Oestradiol-containing preparations are
preferred in women with a history of
d) The endometrial safety of low-
dose vaginal oestrogen has been
demonstrated with up to 2 years of
5. Vaginal moisturising agents, such as
a) Improve atrophic symptoms including
vaginal itching, irritation, and
b) Are mainly used to reduce irritation
c) Have been shown to reduce the
incidence of recurrent urinary tract
d) Do not provide sustained symptomatic
There are conflicting data on the
safety of intravaginal oestrogen
therapy in breast cancer survivors.8
Some systemic absorption of oestrogen
can occur and so the safety of these
preparations in women with a prior
diagnosis of breast cancer and potential
impact on breast cancer recurrence
is uncertain.8,12 Oestradiol has a more
significant effect on serum oestrogen
concentration than oestriol and may
reverse the anti-oestrogen action of
12,21 If vaginal
oestrogens are to be used following
breast cancer, particularly in women
taking an aromatase inhibitor, then
oestriol-containing preparations may
Ultimately, the decision
to use oestrogen therapy for women
with a history of breast cancer depends
on the woman’s preference, need,
understanding of potential risks, and
consultation with her oncologist.5
• Approximately half of all
post-menopausal women will
experience symptoms related to
• Symptoms of vulvovaginal atrophy
can have a significant impact on
sexual function and quality of life.
• Non-hormonal vaginal lubricants and
moisturisers are first-line treatment
for symptomatic vulvovaginal atrophy.
• Replens is a long-acting vaginal
moisturising gel that, with regular
use, improves vaginal moisture,
secretions, elasticity, pH, and
symptoms of vulvovaginal atrophy,
including dryness, itching, irritation
• Intravaginal oestrogen therapy may
be used for women whose symptoms
do not respond to non-hormonal
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endocrinology. Version 5. Melbourne: Therapeutic Guidelines
13. Dezzutti CS, Brown ER, Moncla B, et al. Is wetter better? An
evaluation of over-the-counter personal lubricants for safety
and anti-HIV-1 activity. PLos One 2012; 7:e48328.
14. Cancer Australia. The psychosexual care of women
affected by gynaecological cancers: a learning resource
for health-care professionals. 2010. At: http://modules.
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delivery. Adv Drug Deliv Rev 2005; 57(11):1692–712.
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estrogen in menopausal women. Fertil Steril 1994;61(1):178–
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nonhormonal treatment of vaginal dryness. Clinical Practice
in Sexuality 1992; 8(8/9):3–8.
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cream in the symptomatic treatment of vaginal atrophy in
postmenopausal women. Maturitas 1996; 23:259–63,
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atrophy in postmenopausal women. Cochrane Database
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vaginally administered estrogen therapy: a review. J Pelvic
Med Surg 2009; 15(3):105–14.
21. Lindahl SH. Reviewing the options for local estrogen
treatment of vaginal atrophy. Int J Women’s Health
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guidelines for assessing and managing menopausal
symptoms after breast cancer. Annals of Oncology 2008;
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