Gynecologist and Menopausal Patient Perspectives on Vaginal Hormone Therapy for the Management of the Genitourinary Syndrome of Menopause in Canada: A Real-World Survey.

PURPOSE: The genitourinary syndrome of menopause (GSM) is common during menopause and can have a profound negative impact on quality of life. Vaginal hormone therapy (HT) is a guideline-recommended second-line treatment for GSM but its real-world utilization in Canada is poorly described in the literature. The objectives of this real-world study were to examine current patterns of practice and potential gaps in the management of GSM in Canada and to evaluate factors affecting patient satisfaction with vaginal hormone therapy for GSM.

PATIENTS AND METHODS: Real-world study that surveyed 13 Canadian gynecologists and 119 patients diagnosed with GSM who were eligible for vaginal HT but had not been prescribed this treatment (naïve cohort) or were currently being treated with vaginal HT (on-treatment cohort). Data were analyzed using descriptive statistics.

RESULTS: The main therapies prescribed by gynecologists for GSM were vaginal moisturizers or lubricants (49%), vaginal estrone/conjugated estrogen creams (35%), vaginal estradiol inserts (26%) or tablets (20%), and vaginal dehydroepiandrosterone (DHEA) ovules (12%). Among vaginal HT-naïve patients, the most important factors impacting treatment selection were ease of use, onset of action, and low risk of systemic hormone absorption. Most patients in the on-treatment cohort (77%) were satisfied with their current vaginal HT yet 77% would consider switching treatment most commonly due to convenience factors. After consultation with their gynecologist, 43% of patients on vaginal HT switched treatment, mainly to estradiol inserts (43%) or DHEA ovules (36%). Even patients who had no change to their GSM treatment had experienced issues with their current vaginal HT, suggesting an opportunity to discuss alternative treatment options with their gynecologist.

CONCLUSION: Gaps and opportunities to improve the current management of GSM in Canada were identified. Discussions about GSM and available treatment options could be strengthened to support shared decision-making.