REVIEW Management of urogenital atrophy in breast cancer patients: a systematic review of available evidence from randomized trials Sasha Mazzarello 1 • Brian Hutton 2 • Mohammed F. K. Ibrahim 3 • Carmel Jacobs 3 • Risa Shorr 4 • Stephanie Smith 1 • Terry Ng 3 • Mark Clemons 1,3 Received: 14 May 2015 / Accepted: 18 May 2015 Ó Springer Science+Business Media New York 2015 Abstract Symptoms of urogenital atrophy are common in breast cancer survivors. Its optimal management is currently unknown. A systematic review of randomized controlled trials (RCTs) evaluating treatments for uro- genital atrophy in breast cancer patients was performed. EMBASE, Ovid Medline and the Cochrane Library were searched from 1946 to November 2014. Outcomes in- cluded improvements in both vaginal symptoms (e.g., dryness, pain, dyspareunia and itching) and vaginal hor- mone response measured by validated scales [e.g., Vaginal Health Index (VHI) and Vaginal Maturation Index (VMI)]. Of 430 unique citations identified, 4 studies (n = 196) met inclusion criteria. Interventions included pH-balanced gel, Replens Ò , lidocaine, Estring Ò and Vagifem Ò . Sample sizes ranged from 7 to 98 patients. Given the heterogeneity of the studies, a narrative synthesis of results was performed. One study of 98 patients suggested that vaginal pH-bal- anced gel (mean VHI 5.00 ± 0.816, mean VMI 51.18 ± 3.753) was more efficient than placebo (VHI 16.98 ± 3.875, p \ 0.001, VMI 47.87 ± 2.728, p \ 0.001) at 12 weeks in providing vaginal symptom re- lief. In patients who used lidocaine, 90 % had reduced dyspareunia compared to saline in a study of 46 patients. Although increased serum estradiol occurred, both Estring Ò and Vagifem Ò were shown to improve quality of life and VMI in a study of seven patients. Treatment of urogenital atrophy remains a challenging issue and there is a paucity of RCT evidence addressing this knowledge gap. It is evident that more prospective trials are needed. Keywords Urogenital atrophy Á Topical moisturizers Á Topical estrogen Á Intra-vaginal estrogens Background Urogential symptoms such as vaginal dryness, dyspareunia, itching, discharge, urinary incontinence, urinary tract in- fections and discharge are common in healthy post-meno- pausal women [1]. These symptoms can have a considerable negative impact on a woman’s quality of life [2]. As a consequence of cancer and its therapy, up to 75 % of breast cancer survivors experience at least one urogenital symp- tom [3, 4]. As both tamoxifen and aromatase inhibitors are frequently associated with urogenital symptoms, urogenital atrophy has become an increasingly important and chal- lenging clinical issue given the improved longevity of breast cancer patients and increasing recommendations for extended endocrine therapy [5]. In a non-breast cancer population, while a range of preparations such as vaginal moisturizers (e.g., Replens Ò , Emerita Ò , RepHresh Ò ) and lubricants (e.g., Astroglide Ò , K-Y jelly Ò ) are commonly used, it is intravaginal estrogen preparations that offer the most effective treatment in al- leviating symptoms of urogenital atrophy [6]. However, in Electronic supplementary material The online version of this article (doi:10.1007/s10549-015-3434-z) contains supplementary material, which is available to authorized users. & Mark Clemons mclemons@toh.on.ca 1 Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, Canada 2 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada 3 Division of Medical Oncology and Department of Medicine, The Ottawa Hospital Cancer Centre, University of Ottawa, 501 Smyth Road, Box 912, Ottawa, ON K1H 8L6, Canada 4 The Ottawa Hospital, Ottawa, Canada 123 Breast Cancer Res Treat DOI 10.1007/s10549-015-3434-z