Reviewing the options for local estrogen treatment of vaginal atrophy

Sarah H Lindahl, Sarah H Lindahl

Abstract

Background: Vaginal atrophy is a chronic condition with symptoms that include vaginal dryness, pain during sex, itching, irritation, burning, and discharge, as well as various urinary problems. Up to 45% of postmenopausal women may be affected, but it often remains underreported and undertreated. This article aims to review the current recommendations for treatment of vaginal atrophy, and current data on the effectiveness and safety of local vaginal estrogen therapies.

Methods: Literature regarding vaginal atrophy (2007-2012) was retrieved from PubMed and summarized, with emphasis on data related to the treatment of vaginal atrophy with local vaginal estrogen therapy.

Results: Published data support the effectiveness and endometrial safety of low-dose local estrogen therapies. These results further support the general recommendation by the North American Menopause Society that a progestogen is not needed for endometrial protection in patients using low-dose local vaginal estrogen. Benefits of long-term therapy for vaginal atrophy include sustained relief of symptoms as well as physiological improvements (eg, decreased vaginal pH and increased blood flow, epithelial thickness, secretions).

Conclusion: Currently available local vaginal estrogen therapies are well tolerated and effective in relieving symptoms of vaginal atrophy. Recent data support the endometrial safety of low-dose regimens for up to 1 year.

Keywords: estrogen; local estrogen therapy; menopause; vaginal atrophy.

References

    1. Mac Bride MB, Rhodes DJ, Shuster LT. Vulvovaginal atrophy. Mayo Clin Proc. 2010;85(1):87–94.
    1. Stika CS. Atrophic vaginitis. Dermatol Ther. 2010;23(5):514–522.
    1. Santoro N, Komi J. Prevalence and impact of vaginal symptoms among postmenopausal women. J Sex Med. 2009;6(8):2133–2142.
    1. Nappi RE, Kokot-Kierepa M. Women’s voices in the menopause: results from an international survey on vaginal atrophy. Maturitas. 2010;67(3):233–238.
    1. Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society. Menopause. 2013;20(9):888–902.
    1. Krychman ML. Vaginal estrogens for the treatment of dyspareunia. J Sex Med. 2011;8(3):666–674.
    1. Robinson D, Cardozo L. Estrogens and the lower urinary tract. Neurourol Urodyn. 2011;30(5):754–757.
    1. Hillard T. The postmenopausal bladder. Menopause Int. 2010;16(2):74–80.
    1. Sturdee DW, Panay N, International Menopause Society Writing Group Recommendations for the management of postmenopausal vaginal atrophy. Climacteric. 2010;13(6):509–522.
    1. Jaisamrarn U, Triratanachat S, Chaikittisilpa S, Grob P, Prasauskas V, Taechakraichana N. Ultra-low-dose estriol and lactobacilli in the local treatment of postmenopausal vaginal atrophy. Climacteric. 2013;16(3):347–355.
    1. Nachtigall LE. Comparative study: Replens versus local estrogen in menopausal women. Fertil Steril. 1994;61(1):178–180.
    1. Osphena (ospemifene) [prescribing information] Florham Park, NJ: Shionogi Inc;
    1. Nappi RE, Kokot-Kierepa M. Vaginal Health: Insights, Views and Attitudes (VIVA) – results from an international survey. Climacteric. 2012;15(1):36–44.
    1. American College of Obstetricians and Gynecologists Women’s Health Care Physicians. Hormone Therapy. Sexual Dysfunction. Obstet Gynecol. 2004;104(4):S85–S91.
    1. Scarabin PY, Oger E, Plu-Bureau G, EStrogen and THromboEmbolism Risk Study Group Differential association of oral and transdermal oestrogen-replacement therapy with venous thromboembolism risk. Lancet. 2003;362(9382):428–432.
    1. Lokkegaard E, Andreasen AH, Jacobsen RK, Nielsen LH, Agger C, Lidegaard O. Hormone therapy and risk of myocardial infarction: a national register study. Eur Heart J. 2008;29(21):2660–2668.
    1. Canonico M, Plu-Bureau G, Lowe GD, Scarabin PY. Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: systematic review and meta-analysis. BMJ. 2008;336(7655):1227–1231.
    1. Margolis KL, Bonds DE, Rodabough RJ, et al. Effect of oestrogen plus progestin on the incidence of diabetes in postmenopausal women: results from the Women’s Health Initiative Hormone Trial. Diabetologia. 2004;47(7):1175–1187.
    1. Premarin (conjugated estrogens) vaginal cream [prescribing information] Philadelphia, PA: Wyeth Pharmaceuticals Inc, part of Pfizer;
    1. Estrace (estradiol vaginal cream, USP, 0.01%) [prescribing information] Rockaway, NJ: Warner Chilcott (US), LLC;
    1. Bachmann G, Bouchard C, Hoppe D, et al. Efficacy and safety of low-dose regimens of conjugated estrogens cream administered vaginally. Menopause. 2009;16(4):719–727.
    1. Estring (estradiol vaginal ring) [prescribing information] New York, NY: Pharmacia and Upjohn Company, Division of Pfizer Inc;
    1. Weisberg E, Ayton R, Darling G, et al. Endometrial and vaginal effects of low-dose estradiol delivered by vaginal ring or vaginal tablet. Climacteric. 2005;8(1):83–92.
    1. Femring (estradiol acetate vaginal ring) [prescribing information] Rockaway, NJ: Warner Chilcott (US), LLC;
    1. Henriksson L, Stjernquist M, Boquist L, Cedergren I, Selinus I. A one-year multicenter study of efficacy and safety of a continuous, low-dose, estradiol-releasing vaginal ring (Estring) in postmenopausal women with symptoms and signs of urogenital aging. Am J Obstet Gynecol. 1996;174(1):85–92.
    1. Vagifem (estradiol vaginal tablets) [prescribing information] Princeton, NJ: Novo Nordisk Inc;
    1. Birkhauser MH, Panay N, Archer DF, et al. Updated practical recommendations for hormone replacement therapy in the peri- and postmenopause. Climacteric. 2008;11(2):108–123.
    1. US Department of Health and Human Services, Food and Drug Administration, Center for Drug Evaluation and Research (CDER) Guidance for industry: labeling guidance for noncontraceptive estrogen drug products for the treatment of vasomotor symptoms and vulvar and vaginal atrophy symptoms – prescribing information for health care providers and patient labeling. [Accessed November 30, 2011]. Available from: .
    1. Simon J, Nachtigall L, Gut R, Lang E, Archer DF, Utian W. Effective treatment of vaginal atrophy with an ultra-low-dose estradiol vaginal tablet. Obstet Gynecol. 2008;112(5):1053–1060.
    1. Ulrich LS, Naessen T, Elia D, Goldstein JA, Eugster-Hausmann M. Endometrial safety of ultra-low-dose Vagifem 10 microg in postmenopausal women with vaginal atrophy. Climacteric. 2010;13(3):228–237.
    1. Simon J, Nachtigall L, Ulrich LG, Eugster-Hausmann M, Gut R. Endometrial safety of ultra-low-dose estradiol vaginal tablets. Obstet Gynecol. 2010;116(4):876–883.
    1. Bachmann G. The estradiol vaginal ring – a study of existing clinical data. Maturitas. 1995;22(Suppl):S21–S29.
    1. Eugster-Hausmann M, Waitzinger J, Lehnick D. Minimized estradiol absorption with ultra-low-dose 10 microg 17beta-estradiol vaginal tablets. Climacteric. 2010;13(3):219–227.
    1. Dorr MB, Nelson AL, Mayer PR, et al. Plasma estrogen concentrations after oral and vaginal estrogen administration in women with atrophic vaginitis. Fertil Steril. 2010;94(6):2365–2368.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する