The number of women over the age of 65 is projected to almost double in the next 20 years, and clinicians need to be comfortable treating conditions common to this cohort. This review covers several common gynecologic conditions seen in older women, including atrophic vaginitis, lichen sclerosis, pelvic floor disorders, and postmenopausal bleeding. We conclude with evidence-based screening recommendations for gynecologic cancers in older women and tips on doing a pelvic examination.
Get full access to this article
View all access options for this article.
References
1.
Department of Health and Human Services Administration on Aging. Aging statistics. www.aoa.gov/aoaroot/aging_statistics/index.aspx. 2011 February 1.
2.
Mac BrideMB, RhodesDJ, ShusterLT. Vulvovaginal atrophy. Mayo Clin Proc., 2010; 85:87–94.
3.
DennersteinL, DudleyE, HopperJL, GuthrieJR, BurgerHG. A prospective population-based study of menopausal symptoms. Obst Gynecol, 2000; 96:351–358.
OribaHA, MaibachHI. Vulvar transepidermal water loss (TEWL) decay curves. Effect of occlusion, delipidation, and age. Acta Derm Venereol, 1989; 69:461–465.
8.
SemmensJP, WagnerG. Estrogen deprivation and vaginal function in postmenopausal women. JAMA, 1982; 248:445–448.
9.
RoyS, CaillouetteJC, RoyT, FadenJS. Vaginal pH is similar to follicle-stimulating hormone for menopause diagnosis. Am J Obstet Gynecol, 2004; 190:1272–1277.
10.
BachmannGA, NevadunskyNS. Diagnosis and treatment of atrophic vaginitis. Am Fam Physician., 2000; 61:3090–3096.
11.
SucklingJ, KennedyR, LethabyA. Local oestrogens for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev, 2006; 4:CD001500.
12.
North American Menopause Society. The role of local vaginal estrogen for treatment of vaginal atrophy in postmenopausal women: 2007 position statement of The North American Menopause Society. Menopause, 2007; 14:355.
13.
HallopeauH. Du lichen plan et particulièrement de sa forme atrophique: Lichen plan scléreux. Ann Dermatol Syphiligr (Paris), 1887; 8:790–791.
14.
MeyrickT, RidleyCM, McGibbonDH, BlackMM. Lichen sclerosus et atrophicus and autoimmunity: A study of 350 women. Br J Dermatol, 1988; 118:41–46.
15.
De VitoJR, MerogiAJ, VoTet al.Role of Borrelia burgdorferi in the pathogenesis of morphoea/scleroderma and lichen sclerosus et atrophicus: A PCR study of thirty-five cases. Br J Dermatol, 2000; 142:481–484.
16.
FujiwaraH, FujiwaraK, HashimotoKet al.Detection of Borrelia burgdorferi DNA (B. garinii or B. afzelii) in morphoea and lichen sclerosus et atrophicus tissue of German and Japanese but not US patients. Arch Dermatol, 1997; 133:41–44.
17.
CarlsonJA, AmbrosR, MalfetanoJet al.Vulvar lichen sclerosus and squamous cell carcinoma: A cohort, case control, and investigational study with historical perspective: Implications for chronic inflammation and sclerosis the development of neoplasia. Hum Pathol, 1998; 29:932–948.
NeillSM, TatnallFM, CoxNH. Guidelines for the management of lichen sclerosus. Br J Dermatol, 2002; 147:640–649.
22.
MazdisnianF, DegregorioF, PalmieriA. Intralesional injection of triamcinolone in the treatment of lichen sclerosus. J Reprod Med, 1999; 44:332–334.
23.
JonesR, ScurryJ, NeillS, MacLeanAB. Guidelines for the follow-up of women with vulvar lichen sclerosus in specialist clinics. Am J Obstet Gynecol, 2008; 198:496.e1–496.e3.
24.
NygaardI, BarberMD, BurgioKLet al.Prevalence of symptomatic pelvic floor disorders in women. JAMA, 2008; 300:1311–1316.
25.
LuberKM, BoeroS, ChoeJY. The demographics of pelvic floor disorders: Current observations and future projections. Am J Obstet Gynecol, 2001; 184:1496–1501.
26.
McNevinS. Overview of pelvic floor disorders. Surg Clin North Am, 2010; 90:195–205.
27.
SungVW, HamptonBS. Epidemiology of pelvic floor dysfunction. Obstet Gynecol Clin North Am., 2009; 36:421–443.
28.
EllerkmannRM, CundiffGW, MellickCF, NiharaMA, LefflerK, BentAE. Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol, 2001; 185:1332–1337.
29.
HagenS, StarkD, MaherC, AdamsE. Conservative management of pelvic organ prolapse in women. Cochrane Database Syst Rev, 2006; 4:CD003882
30.
American College of Obstetricians and Gynecologists. Pelvic organ prolapse. Washington, DC: ACOG, 2007.
31.
AstrupK. Frequency of spontaneously occurring postmenopausal bleeding in the general population. Acta Obstst Gynecol Scand, 2004; 83:203–207.
32.
HaleGE, Fraser IS. Changes in the menstrual pattern during the menopause transition. LoboRA. Treatment of the postmenopausal woman: Basic and clinical aspects. 3rd. Burlington, MA: Elsevier, 2007.
33.
American Cancer Society. Cancer facts and figures 2010. www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-026238.pdf. 2010 December 7.
34.
TaborA, WattHC, WaldNJ. Endometrial thickness as a test for endometrial cancer in women with postmenopausal vaginal bleeding. Obstet Gynecol, 2002; 99:663–670.
35.
GoldsteinSR. The role of transvaginal ultrasound or endometrial biopsy in the evaluation of the menopausal endometrium. Am J Obstet Gynecol, 2009; 201:5–11.
36.
TimmermansA, OpmeerBC, KhanKSet al.Endometrial thickness measurement for detecting endometrial cancer in women with postmenopausal bleeding: A systematic review and meta-analsysis. Obstet Gynecol, 2010; 116:160–167.
37.
DijkhuizenFP, MolBW, BrolmannHAet al.The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: A meta-analysis. Cancer, 2000; 89:1765–1772.
38.
SpicerJM, SiebertK, KrugerTF. Postmenopausal bleeding: A diagnostic approach for both private and public sectors. Gynecol Obstet Invest, 2006; 61:174–178.
39.
American College of Obstetricians and Gynecologists. Practice bulletin No. 109: Cervical cytology screening. Obstet Gynecol, 2009; 114:1409–1420.
40.
U.S. Preventive Service Task Force. Screening for ovarian cancer. 2004. www.uspreventiveservicestaskforce.org/3rduspstf/ovariancan/ovcanrs.htm. 2011 January 21.
41.
WesthoffCL, JonesHE, GuiahiM. Do new guidelines and technology make the routine pelvic examination obsolete?J Womens Health, 2011; 20:5–10.
42.
MurrayJ. Geriatric gynecology. GalloJJ, Busby-WhiteheadJ, RabinsPV, StillmanRA, MurphyJB, ReichelW. Reichel's care of the elderly: Clinical aspects of aging. Philadelphia: Lippincott Williams & Wilbins, 1999; 392–406.
43.
American College of Obstetricians and Gynecologists. Practice bulletin No. 431: Routine pelvic examination and cervical cytology screening. Obstet Gynecol, 2009; 113:1190–1193.
44.
StewartR, ThistlethwaiteJ, EvansR. Pelvic examination of asymptomatic woman. Aust Fam Physician, 2008; 37:493–496.
