The REVIVE (REal Women’s VIews of Treatment Options for Menopausal Vaginal ChangEs) survey in Europe: Country-specific comparisons of postmenopausal women’s perceptions, experiences and needs
Introduction
One of the main consequences of reduced estrogen levels after menopause is vulvar and vaginal atrophy (VVA), which affects almost 40–60% of postmenopausal women [1], [2], [3], [4], [5], [6] and is part of the more general genitourinary syndrome of menopause [7], [8]. Women who suffer from this medical condition often have a combination of symptoms that include loss of vaginal elasticity, dryness, decreased lubrication, irritation, and dyspareunia which significantly impact daily and sexual life in aging populations [3], [9]. Despite the social impact of VVA and the availability of therapeutic agents, many women do not report their symptoms to healthcare professionals (HCP) and thus their clinical status remains underdiagnosed and untreated [10].
Many HCPs and patients report difficulty in broaching the subject during consultations due to the embarrassment in acknowledging symptomatology [11], [12], [13], [14]. Therefore, underreported symptoms are usually followed by significant disease progression in many women and a considerable period of chronic suffering [15]. Moreover, the frequently-observed late diagnosis combined with concerns expressed both by patients and HCPs regarding the long-term safety of estrogen-containing product application, and the inconvenience of topical product application can compromise the therapeutic approach of VVA and the treatment adherence [16], [17]. Currently available treatments include topical over-the-counter (OTC) non-hormonal moisturizers and lubricants, as well as prescribed systemic hormonal and local vaginal estrogen treatments [3].
Results from several cross-cultural surveys have found that VVA has a global, general negative impact on sexual health, behavior and satisfaction of postmenopausal women, beyond the possible confounding factors due to population heterogeneity and limited diagnostic criteria [10], [14], [18], [19], [20]. Recently, a large study based on an online questionnaire was published with the aim of characterizing the experience and perception of VVA symptoms by postmenopausal women and to further elucidate the state of the current interactions with HCPs in Europe: the REVIVE-EU (REal Women’s VIews of Treatment Options for Menopausal Vaginal ChangEs—Europe) [21].
The objective of the present analysis, based on the REVIVE-EU survey, was to better understand the inter-country variation (in Europe) of women’s perceptions, experiences and needs in relation to sexual and vaginal health, highlighting common and socio-culturally specific aspects of the four European countries studied (Germany, Italy, Spain and United Kingdom). The aim of this analysis was to gain information on the four countries women’s awareness of VVA, its impact on women’s lives as well as to collect data on HCP relationships and attitudes towards VVA treatments together with information seeking behavior.
Section snippets
Population
The European REVIVE included a total cohort of 3768 postmenopausal women with VVA symptoms from four European countries (1000 from Germany, 1000 from Italy, 1000 from the United Kingdom, and 768 from Spain). The inclusion criteria were: natural or surgically induced menopausal women, residence in one of the four study countries, aged between 45–75 years old, experience of one or more vulvar and/or vaginal atrophy symptoms (dryness, pain with sex, irritation, tenderness, pain with exercise
Survey population distribution
The baseline demographics and clinical characteristics of the survey participants from the four countries are summarized in Table 1. The average age of the Spanish sample was the lowest with 55.3% belonging to the 45–55 age group and only 3.6% of participants being older than 65 years old. In contrast, the UK sample was significantly older (25.0% in the 45–55 years age group and 23.5% over 65 years old). Among the cohort of surveyed participants (Fig. 1), around 44% of the participants in Spain
Discussion
The European REVIVE survey of 3768 postmenopausal women with diagnosed VVA was the largest cohort of participants included in a study of this nature to date [21]. The REVIVE study highlighted several limitations in diagnosis, clinical management and treatment approaches for this chronic condition in Europe, as well as considerable lack of awareness of VVA underlying causes in postmenopausal sufferers. For the first time, this analysis aimed to investigate the population and country variation
Conclusions
Regardless of cultural differences and the role of different health systems, postmenopausal women shared the expectation that a treatment should improve the quality of their sex lives and promote a return of the body and genital organs to a pre-menopause state. Nevertheless, the method to achieve this was varied among different European countries, most influenced by the nature of their health care system, the involvement of patients in treatment decisions and the effective communication
Contributors
REN, SP and NP designed the study.
REN, SP, MP and NP developed the methodology.
REN, SP and NP collected the data.
MP performed the analysis.
REN wrote the manuscript.
SP, MP and NP critically revised the manuscript.
All authors gave final approval of the version to be published.
Conflict of interest
Rossella E. Nappi had a financial relationship (lecturer, member of advisory boards and/or consultant) with Bayer HealthCare AG, Boehringer Ingelheim, Ely Lilly, Endoceutics, Gedeon Richter, HRA Pharma, Merck Sharpe & Dohme, Novo Nordisk, Pfizer Inc, Procter & Gamble Co, Shionogi Limited and TEVA Women’s Health Inc.
Santiago Palacios has been a symposium speaker or advisory board member for Servier, Pfizer, GSK, Abbott, Ferrer, Bioiberica, Shionogi, Amgen, Novo Nordisk and Teva. He has also
Funding
Financial support for the REVIVE Survey was provided by Shionogi Limited.
Ethical approval
The comprehensive online questionnaire was approved by the corresponding accredited institutional review boards at the respective institutions (University of Pavia, Palacios Institute of Women‘s Health, Imperial College London). All survey participants were appropriately informed of the nature of the study and gave informed consent to participate before completing the online questionnaire.
Provenance and peer review
This article has undergone peer review.
Acknowledgements
The authors would like to thank Emili González-Pérez (TFS Develop), Scientific Advisor and Medical Writer, for his assistance with manuscript preparation. Sponsorship and article processing charges for this study were funded by Shionogi, Inc.
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