Traitements physiques de l’atrophie vulvovaginale. RPC Les femmes ménopausées du CNGOF et du GEMVi

International audienceFor some patients, local hormonal or non-hormonal treatments for genitourinary syndrome of menopause (SGUM) are contraindicated or insufficiently effective. Different physical therapies such as vaginal laser therapy, radiofrequency therapy, photobiomodulation therapy and local injection of hyaluronic acid, autologous fat (lipofilling) and platelet rich plasma (PRP) have been proposed as alternatives.Objective: The objective of this review was to elaborate guidelines for clinical practice regarding the physical therapies proposed for management of vulvovaginal atrophy (AVV).Methods: A systematic review of the literature on AVV management with physical therapies was conducted on Medline between January 2014 and December 2020.Results: Regarding vaginal laser therapy, there are few randomized controlled trials and no formal conclusions can be drawn. The fractional CO2 laser did not demonstrate its superiority over local estrogen therapy. The ERBIUM:YAG laser has not been studied in randomized controlled trials. The lack of follow-up on the vaginal laser and the series of cases reporting risks of vaginal stenosis or chronic pain do not encourage recommending it as a first-line treatment. The literature concerning other physical treatments of AVV is weak concerning the genital area.Conclusion: CO2 or ERBIUM:YAG vaginal lasers are not the first-line treatment for AVV (grade C). In patients with a contraindication to local hormonal treatments, treatment with vaginal CO2 laser or ERBIUM:YAG may be considered after information about the risks (burn, stenosis, pain) (expert opinion). The other physical treatments of SGUM have to be evaluated.Chez certaines patientes, les traitements locaux, hormonaux ou non, du syndrome génito-urinaire de la ménopause (SGUM) sont contre-indiqués ou insuffisamment efficaces. Différents traitements physiques, tels que le laser vaginal, la radiofréquence, la photobiomodulation, l’injection locale d’acide hyaluronique, de graisse autologue (lipofilling) et de plasma riche en plaquettes (PRP), ont été proposés comme alternatives.L’objectif de ce travail est d’élaborer des recommandations pour la pratique clinique concernant ces nouvelles thérapeutiques proposées dans la prise en charge de l’atrophie vulvovaginale (AVV).Une recherche bibliographique dans la base de données Medline a été effectuée entre janvier 2014 et décembre 2020 concernant les traitements physiques de l’AVV.Concernant les thérapies par laser vaginal, il existe peu d’essais contrôlés randomisés et aucune conclusion formelle ne peut être retenue. Dans ces premiers essais, le laser CO2 fractionné n’a pas démontré sa supériorité face à l’œstrogénothérapie locale. Le laser ERBIUM :YAG n’a pas fait l’objet d’essais contrôlés randomisés. Le manque de recul sur le laser vaginal et les séries de cas rapportant des risques de sténose vaginale ou de douleurs chroniques n’incitent pas à le recommander en première intention. La littérature concernant les autres traitements physiques de l’AVV est pauvre concernant la sphère génitale.Les lasers vaginaux CO2 ou ERBIUM:YAG ne constituent pas les traitements à proposer en première intention dans l’AVV (grade C). Chez les patientes présentant une contre-indication aux traitements hormonaux locaux, un traitement par laser vaginal CO2 ou ERBIUM:YAG pourrait s’envisager après information des risques (brûlure, sténose, douleur) (avis d’experts). Les autres traitements physiques du SGUM sont en cours d’évaluation

Programme de préservation de la fertilité féminine au CHRU de Montpellier 2ans après

International audienceOBJECTIVE:Female fertility preservation in the context of cancer management is crucial for patient's health care. The aim of this study was to evaluate the oncofertility practice at our university hospital of Montpellier since 2011.PATIENTS AND METHODS:The evaluation of management of young patients referred to Montpellier University Hospital from September 2011 to September 2013 for oncofertility counselling before cancer treatment.RESULTS:Seventy-one patients were referred to a specialized oncofertility center. Forty-two patients (59.1%) were included in the oncofertility program. Twenty-two patients (31%) were proposed for oocyte vitrification after COS protocol, eight patients (11.3%) for ovarian tissue cryoconservation, seven patients (9.9%) for GnRH injections, three patients (4.2%) ovarian transposition and two patients (2.8%) for embryo cryopreservation. Among the 42 indications of fertility preservation, only 18 will have finally taken place.CONCLUSION:Oncofertility counselling for young patients should now be part of the cancer management. It involves multidisciplinary teams. Further information of both oncologists and patients is needed to improve this new approach in the field of cancer treatments