farmaecFARMAKOEKONOMIKA. Modern Pharmacoeconomics and PharmacoepidemiologyФАРМАКОЭКОНОМИКА. Современная фармакоэкономика и фармакоэпидемиология2070-49092070-4933IRBIS LLC10.17749/2070-4909/farmakoekonomika.2025.314farmaec-1231Research ArticleREVIEW ARTICLESОБЗОРНЫЕ ПУБЛИКАЦИИCurrent approaches to the treatment of vulvovaginal atrophy in women with gynecological and breast cancerСовременные подходы к лечению вульвовагинальной атрофии у женщин с гинекологическим раком и раком молочных железhttps://orcid.org/0000-0001-7930-6018ГридасоваО. С.GridasovaO. S.

Гридасова Ольга Сергеевна

пер. Яковоапостольский, д. 8А, Москва 105064

Olga S. Gridasova 

8А Yakovoapostolsky Passage, Moscow 105064

https://orcid.org/0000-0002-7456-2386СолоповаА. Г.SolopovaA. G.

Солопова Антонина Григорьевна, д.м.н., проф.

WoS ResearcherID: Q-1385-2015. Scopus Author ID: 6505479504

ул. Трубецкая, д. 8/2, Москва 119048

Antonina G. Solopova, Dr. Sci. Med., Prof. 

8/2 Trubetskaya Str., Moscow 119048

РумянцеваЕ. И.RumyantsevaE. I.

Румянцева Елена Ивановна, доцент

2-я Бауманская ул., д. 5, стр. 1, Москва 105005

Elena I. Rumyantseva, Assoc. Prof. 

5 bldg 1 2nd Baumanskaya Str., Moscow 105005

https://orcid.org/0000-0003-1115-3144ИвановА. Е.IvanovA. E.

Иванов Александр Евгеньевич, к.м.н.

Коломенский пр-д, д. 4, Москва 115446

Aleksandr E. Ivanov, PhD 

4 Kolomensky Dr., Moscow 115446

https://orcid.org/0000-0002-6620-2073УткинД. О.UtkinD. О.

Уткин Дмитрий Олегович, к.м.н.

WoS ResearcherID: HSF-1307-2023

Коломенский пр-д, д. 4, Москва 115446

Dmitry О. Utkin, PhD 

4 Kolomensky Dr., Moscow 115446

https://orcid.org/0000-0002-0725-9686ХизроеваД. Х.KhizroevaJ. Kh.

Хизроева Джамиля Хизриевна, д.м.н., проф.

WoS ResearcherID: F-8384-2017. Scopus Author ID: 57194547147

ул. Трубецкая, д. 8/2, Москва 119048

Jamilya Kh. Khizroeva, Dr. Sci. Med., Prof. 

8/2 Trubetskaya Str., Moscow 119048

jamatotu@gmail.comКлиника Real Trans HairРоссияReal Trans Hair СlinicRussian FederationФедеральное государственное автономное образовательное учреждение высшего образования «Первый Московский государственный медицинский университет им. И.М. Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский Университет)РоссияSechenov UniversityRussian FederationФедеральное государственное автономное образовательное учреждение высшего образования «Московский государственный технический университет им. Н.Э. Баумана (национальный исследовательский университет)РоссияBauman Moscow State Technical UniversityRussian FederationГосударственное бюджетное учреждение здравоохранения г. Москвы «Городская клиническая больница им. С.С. Юдина Департамента здравоохранения г. Москвы»РоссияYudin City Clinical HospitalRussian Federation202506082025182284–293Copyright © Gridasova O.S., Solopova A.G., Rumyantseva E.I., Ivanov A.E., Utkin D.О., Khizroeva J.K., 20252025Гридасова О.С., Солопова А.Г., Румянцева Е.И., Иванов А.Е., Уткин Д.О., Хизроева Д.Х.Gridasova O.S., Solopova A.G., Rumyantseva E.I., Ivanov A.E., Utkin D.О., Khizroeva J.K.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.pharmacoeconomics.ru/jour/article/view/1231Background

Background. Treatment of vulvovaginal atrophy (VVA) in women diagnosed with gynecologic or breast cancer presents challenges. Treatment options for VVA, the genital manifestation of the genitourinary syndrome of menopause (GSM), generally mirror those used for natural menopause; however, efficacy and safety data specific to this patient group are limited due to their exclusion from clinical trials.

Objective

Objective: To review the literary data on new approaches to the treatment of VVA as a manifestation of GSM in women with gynecological or breast cancer.

Material and methods

Material and methods. The search in PubMed/MEDLINE, Web of Science, Google Scholar, eLibrary, and Scopus databases was performed using the following key phrases: “vulvovaginal atrophy”, “vulvar atrophy after cancer”, “treatment of vulvar atrophy in women with cancer”, “low dose estrogen therapy”, “laser therapy of vulvovaginal atrophy”, “vulvovaginal atrophy following treatment for oncogynecologic pathologies”, “genitourinary syndrome of menopause in breast cancer survivors”, “low dose estrogen therapy”, “laser therapy of vulvovaginal atrophy” in Russian and English. We also reviewed important sources cited in the bibliographies of relevant studies. The review included original and review articles containing the mentioned key phrases and published from 1996 to March 2025.

Results

Results. In women with a history of gynecological or breast cancer, treatment of VVA should be tailored to the individual, and non-hormonal options such as lubricants during sexual activity and regular use of long-lasting vaginal moisturizers are typically the first line of treatment. Fractional CO2 laser therapy is an effective and safe method for gynecological cancer survivors, enhancing sexual life and overall quality of life. In this patient population, hyaluronic acid combined with vitamins A and E has demonstrated a beneficial effect, reducing vaginal dryness and dyspareunia. The use of topical hormonal therapy may be an option for women who do not respond to non-pharmacologic and nonhormonal treatments after discussing the risks and benefits and consulting with an oncologist.

Conclusion

Conclusion. Not all available treatment options are suitable for women with a history of cancer due to the risk of recurrence of hormonedependent cancer associated with estrogen therapy. In this patient population, new treatments such as laser therapy and vaginal injections show promising results with minimal side effects and hormone-independent mechanisms.

Актуальность

Актуальность. Лечение вульвовагинальной атрофии (ВВА) у женщин с диагнозом гинекологического рака или рака молочных желез (РМЖ) является сложной задачей. Методы лечения ВВА как генитального проявления генитоуринарного синдрома менопаузы (ГСМ) обычно отражают подходы, используемые при естественной менопаузе, однако данные об эффективности и безопасности, характерные для этой группы пациенток, ограниченны из-за исключения их из клинических испытаний.

Цель

Цель: провести анализ литературных данных о новых подходах к терапии ВВА как проявления ГСМ у женщин с гинекологическим раком или РМЖ.

Материал и методы

Материал и методы. Проведен поиск в базах данных PubMed/MEDLINE, Web of Science, eLibrary, Google Scholar, Scopus с использованием ключевых словосочетаний «вульвовагинальная атрофия», «вульварная атрофия после рака», «лечение вульварной атрофии у женщин с раком», «терапия низкими дозами эстрогенов», «лазерное лечение вульвовагинальной атрофии» на русском и английском языках. Также поиск выполняли по ключевым ссылкам из библиографий соответствующих исследований. В обзор включали оригинальные и обзорные статьи, содержащие указанные ключевые слова и опубликованные с 1996 г. по март 2025 г.

Результаты

Результаты. У женщин с анамнезом гинекологического рака или РМЖ лечение ВВА должно быть индивидуализировано. Негормональные методы, а именно лубриканты при сексуальной активности и регулярное использование вагинальных увлажнителей длительного действия, обычно являются первой линией терапии. Фракционная лазерная терапия с применением CO2 представляет собой эффективный и безопасный метод для пациенток, переживших гинекологический рак, улучшая сексуальную функцию и качество жизни. Также в этой популяции использование гиалуроновой кислоты вместе с витаминами А и Е продемонстрировало положительный эффект, приводя к уменьшению сухости влагалища и диспареунии. Применение местной гормональной терапии может быть вариантом для пациенток, у которых нефармакологические и негормональные средства оказались неэффективны, после обсуждения рисков и преимуществ, а также консультации с онкологом.

Заключение

Заключение. Не все доступные варианты лечения подходят для женщин с онкологическим анамнезом из-за опасности рецидива гормонозависимого рака, связанного с терапией эстрогенами. В данной популяции новые методы лечения, такие как лазерная терапия и вагинальные инъекции, показывают многообещающие результаты с минимальными побочными эффектами и гормононезависимыми механизмами.

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The authors declare that there are no conflicts of interest present.