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Imvaggis is indicated for the local treatment of vaginal symptoms of oestrogen deficiency in postmenopausal women.1

Vaginal Atrophy under-diagnosed
and under-treated2

Menopause usually begins in women between the age of 45 and 55, but can occur before or after this age. The average age is 51.3  The change in oestrogen levels that takes place at menopause can cause both physical and emotional symptoms, it can also lead to a condition known as Vaginal Atrophy.4,5 Vaginal atrophy can cause pain during sex as well as, making it uncomfortable to sit, stand, exercise, urinate or even work. Vaginal atrophy can affect everyday life, whether women are sexually active or not. This can have a detrimental effect on quality of life.6

 

Before menopause, when the vagina is well supplied with oestrogen, its lining is thicker and has more folds, allowing it to stretch with intercourse and childbirth. After menopause, when levels of oestrogen are low, the vaginal lining is thinner and has fewer folds, which makes it less flexible, due to Vaginal Atrophy (VA) (also referred to as Urogenital Atrophy or Vulvovaginal Atrophy (VVA)) 8

As oestrogen receptors are present on the vagina, urethra, bladder trigone and the pelvic floor, all of these areas can be affected.9 In order to encompass all of these areas the North American Menopause Society (NAMS) and the International Society for the Study of Women’s Sexual Health (ISSWSH) have introduced the term Genitourinary Syndrome of Menopause (GSM) 10

About Vaginal Atrophy

Adapted from Johnston S 2006 and Reiter S 2013.11,12

This diagram is an example of the lining of the vagina before menopause (left side of diagram) and after menopause (right side of diagram).

Guidelines and Recommendations
for Vaginal Atrophy

  • Nice Guidance recommends offering vaginal oestrogen to women with urogenital atrophy and continue treatment for as long as needed to relieve symptoms13
  • It is important that treatment is started early, if possible, to reduce any irreversible changes occurring9
  • Explain to women with urogenital atrophy that: symptoms often come back when treatment is stopped13
  • Women treated with Imvaggis should be reviewed at least annually1

References

1. Imvaggis (estriol) 0.03mg Summary of Product Characteristics. Available from https://www.medicines.ie/medicines/imvaggis-0-03-mg-pessary-34870/spc#tabs Last accessed September 2022 2. Nappi RE, et al. Diagnosis and management of symptoms associated with vulvovaginal atrophy: expert opinion on behalf of the Italian VVA study group. Gynecol Endocrinol. 2016;32(8):602-606 3. Health Service Executive (HSE) Menopause Overview. Available from https://www2.hse.ie/conditions/menopause/ Last Accessed September 2022 4. Mayo Clinic. Vaginal atrophy. Symptoms and causes. Available from https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Last accessed: September 2022 5. May Clinic Menopause Symptoms and Causes. Available from https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397 Last Accessed September 2022 6. Women’s Health Concern (WHC). Vaginal dryness. Available from https://www.womens-health-concern.org/help-and-advice/factsheets/vaginal-dryness/ Last accessed: September 2022 7. Nappi RE, et al. Vaginal Health: Insights, Views & Attitudes (VIVA) – results from an international survey. Climacteric. 2012;15(1):36-44 8. Johnston S. The Recognition and Management of Atrophic Vaginitis. Geriatrics & Aging. 2002;5(7):9-15. 9. Primary Care Women’s Health Forum. Guidance on Diagnosis and Management of Urogenital Atrophy or Genitourinary Syndrome of the Menopause (GSM). Available from https://pcwhf.co.uk/wp-content/uploads/2018/11/GSM-Guideline.pdf. Last accessed: September 2022 10. Portman DJ, et al. Vulvovaginal Atrophy Terminology Consensus Conference panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Menopause 2014; 21: 1063-1068 11. Johnston S. Urogenital Concerns. JOGC. 2006;28(2):S33-S42. 12. Reiter S. Barriers to effective treatment of vaginal atrophy with local estrogen therapy. Int J Gen Med. 2013;6:153-158 13. National Institute for Health and Care Excellence. Clinical Knowledge Summaries. Managing Menopause. Available from https://cks.nice.org.uk/topics/menopause/management/managing-the-menopause/ Last accessed September 2022

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