Platelet-Rich Plasma for Genitourinary Syndrome of Menopause in Breast Cancer Survivors

During menopause, changes can happen in the areas of external genitalia, vagina, urethra, and bladder, and these are referred to as genitourinary syndrome of menopause (GSM). GSM impacts an estimated 50% of postmenopausal women and can have a negative impact on quality of life. GSM is even more prevalent in breast cancer survivors and is particularly challenging for this population as symptoms can worsen over time and some treatments may not be effective. Platelet-rich plasma (PRP) is thought to stimulate angiogenesis and cell signaling for cell regeneration, which means it may be an effective treatment for GSM. This was an uncontrolled pilot study examining the safety, feasibility, and efficacy of vaginal PRP injections for GSM in breast cancer survivors. The study included 6 months of follow-up conducted at a single tertiary referral center between January 2021 and January 2024. Inclusion criteria were English speaking, having the ability to complete questionnaires, being menopausal, and having a histologic confirmation of adenocarcinoma of the breast stage 0 to III. High-risk patients must have been 3 years or more from initial diagnosis without evidence of recurrence. Exclusion criteria were any form of menopausal hormone therapy within 3 months, allergy to lidocaine, prilocaine, or silicone, and personal history of lichen sclerosus or planus, condyloma, gynecologic cancer, vaginal, or pelvic radiation, recurrent urinary tract infection, pelvic organ prolapse greater than stage II, and chronic pelvic pain. The primary outcome for this study was the safety and feasibility of the vaginal injection protocol. Safety was defined as the absence of significant post-injection vaginal pain requiring medication for more than 48 hours, the use of narcotics, or hospital admission, the absence of systemic allergic reaction, the absence of clinically significant changes on vaginal examination, the absence of systemic symptoms within 48 hours, the absence of injection-related issues, or the absence of a failure of sterility (more than 10.0% positive cultures during PRP preparation). Secondary outcomes included 6-month efficacy with both subjective and objective assessment. Final analysis included 20 patients, and all completed treatment and follow-up. Of the included patients, 17 had hormone receptor-positive breast cancer and 13 were on aromatase inhibitor therapy. An additional 3 patients had completed aromatase inhibitor therapy previously. There were no cases of breast cancer recurrence over the course of the study. The injection protocol was well-tolerated by all patients, with a mean treatment time of 9.50± 1.99 minutes. Mean pain score at injection was 3.8 ± 1.94 and 2.58 ± 1.64 after 1 hour. There were no serious adverse events or abnormal systemic reactions. All patients reported mild vaginal pain, vaginal cramping, spotting or vaginal discharge, and burning or irritation at the injection sites, and all symptoms resolved within 24 hours. All secondary outcomes showed significant improvement except the Vaginal Maturation Index (VMI). No differences were noted between patients on aromatase inhibitor therapy versus those who were not. These results indicate that a single treatment of PRP injected vaginally was safe and feasible in this cohort. Secondary measures indicate some efficacy for GSM symptoms. Because of hesitation for some patients to use hormone therapy for the treatment of GSM, it is important to develop other methods for symptom relief, and this study provides evidence for a possible non-hormonal treatment. Future research should focus on the validation of these findings in a larger cohort and implementing rigorous methods such as blinding and standardization of protocols across multiple centers. (Abstracted from Obstet Gynecol. 2025 Nov 1;146(5):728-736. doi: 10.1097/AOG.0000000000006081)