Current approaches to the treatment of vulvovaginal atrophy in women with gynecological and breast cancer

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: 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. 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. 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. 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.

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