Comment on “Platelet-rich Plasma for Genitourinary Syndrome of Menopause in Breast Cancer Survivors”

Menopause causes many physiological changes, including significant vaginal symptoms classified as genitourinary syndrome of menopause (GSM). Changes and symptoms include changing external genitalia, vagina, urethra, and bladder; increasing pH, and decreasing collagen, vascularity, and elasticity, vulvovaginal dryness, burning and irritation, bladder dysfunction, urinary tract infection (UTI), and sexual dysfunction. GSM affects up to half of postmenopausal women and up to 70% of breast cancer survivors. GSM is a challenging issue for breast cancer survivors, as typical treatment is either contraindicated or subject to hesitancy in many cancer survivors. One potential alternative treatment for GSM is platelet-rich plasma (PRP), which may improve angiogenesis and cell signaling from growth factors to relieve symptoms. This study assessed the safety, feasibility, and efficacy of vaginal PRP injections for GSM treatment in breast cancer survivors. This was a single-arm prospective pilot study conducted between January 2021 and January 2024. Eligibility criteria included patients who were 18 years of age or older, able to complete questionnaires, menopausal, and histological confirmation of adenocarcinoma of the breast stages 0 to III. High-risk cancer patients were included if they were 3 or more years past initial diagnosis with no evidence of recurrence. Patients were excluded from the study if they were receiving hormonal therapy within 3 months, had a known allergy to lidocaine, prilocaine, or silicone, a personal history of lichen sclerosus or planus, condyloma, gynecologic cancer, vaginal or pelvic radiation, recurrent UTI, pelvic organ prolapse greater than stage II, or chronic pelvic pain. The primary outcome for this study was the safety and feasibility of the described injection protocol. Safety was defined as the absence of significant postinjection vaginal pain requiring analgesics for >48 hours, the use of narcotics, or hospital admission, systemic allergic reaction, clinically significant changes on vaginal examination, systemic symptoms, such as fever within 48 hours, injection-related issues, or failure of sterility during PRP preparation. Feasibility was defined as 16 or more patients being able to tolerate the injection with pain scores of 4 or less. The secondary outcome for this study was 6-month efficacy of PRP treatment through the assessment of symptoms via standard questionnaires. A total of 20 participants completed the treatment protocol and 6-month follow-up, with a mean age of 53.6 and a mean body mass index of 27.2. All patients tolerated the injection protocol, with a mean time of treatment of 9.50±1.99 minutes. Mean pain score was 3.8±1.94 at injection and 2.58±1.64 after 1 hour. There were no serious adverse events, and all minor symptoms resolved within 24 hours. Significant improvements were shown at weeks 4, 12, and 26 of follow-up in all secondary outcomes except the vaginal maturation index ( P <0.002 for all). There were no significant differences between patients who were on aromatase inhibitor therapy compared with those who were not. These results indicate that the PRP injection protocol described in this study is both safe and feasible, as well as effective for the treatment of GSM in breast cancer survivors. This is consistent with previous literature indicating that PRP may be an effective treatment, but it is the first study of this injection protocol in this population. Future research should focus on validating these results in a larger sample and over a longer period, as well as standardizing PRP preparation and increasing generalizability. (Summarized from Chen AH, Trabuco EC, Chumsri S, et al. Platelet-rich plasma for genitourinary syndrome of menopause in breast cancer survivors. Obstet Gynecol. 2025;146(5):728-736. doi: https://doi.org/10.1097/AOG.0000000000006081)