About 50% of menopausal women experience genitourinary syndrome of menopause (GSM) that involves changes to the genitals, including the vagina, urethra and bladder. When estrogen levels drop during menopause, it can cause the GSM symptoms of vaginal dryness, itching, burning, frequent urinary tract infections and pain during sex. Replenishing the hormone through vaginal estrogen is an effective GSM treatment. But many breast cancer survivors either can't or don't want to use estrogen.
More than 4 million people in the U.S. are breast cancer survivors. GSM affects up to 70% of these survivors. Medications that stop the body from producing estrogen can prevent or stop the spread of breast cancer. However, these antiestrogen therapies, called aromatase inhibitors, also can exacerbate GSM symptoms.
"Our data shows that as many as 20% of breast cancer survivors on aromatase inhibitors will stop taking their medication prematurely because they cause severe GSM symptoms. This early discontinuation of their breast cancer therapy can lead to worse outcomes in breast cancer survivorship. So, clearly, nonhormonal treatment options for GSM are needed," says Anita Chen, M.D., a gynecologist at Mayo Clinic in Florida. Dr. Chen is the lead author of a study published in Obstetrics & Gynecology.
This need drove Dr. Chen to search for another option. Her team conducted a phase 1 clinical trial with 20 breast cancer survivors with GSM to test the efficacy of platelet-rich plasma (PRP), the part of the blood that holds healing properties, to see if it could help. Blood was drawn from each participant and then spun in a centrifuge to obtain platelets and plasma that have self-healing and regenerative effects. PRP was then injected diffusely once into the opening of the vagina and the vaginal canal in each participant.
"After six months, the breast cancer patients' GSM symptoms had significantly improved, including sexual function, urinary symptoms and overall quality of life, even amongst those taking estrogen blockers," says Emanuel Trabuco, M.D., a Mayo Clinic researcher and co-author of the study.
While vasomotor symptoms of menopause, such as hot flashes and night sweats, can improve over time, GSM does not improve without treatment and worsens over time.
"All of our participants completed the injection protocol and rigorous follow-up, which suggests that this population desires treatment for a bothersome condition, one that is likely underreported, underestimated and undertreated," says Dr. Chen. "Most importantly, none of the participants stopped their breast cancer treatment or experienced cancer recurrence during the study."
PRP has been used for years in orthopedics and dermatology, and gynecologists have started looking into it to treat stress urinary incontinence, reproductive medicine and GSM.
The next step in this research includes pursuing a phase 2 randomized controlled clinical trial to compare PRP injection with a placebo to treat GSM in breast cancer survivors and further evaluate its efficacy.
Review the study for a complete list of authors, disclosures and funding.
