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Vaginal Administration of Low-Dose Conjugated Estrogens: Systemic Absorption and Effects on the Endometrium

HANDA, VICTORIA L. MD; BACHUS, KEVIN E. MD; JOHNSTON, WILLIAM W. MD; ROBBOY, STANLEY J. MD; HAMMOND, CHARLES B. MD
Obstetrics & Gynecology: August 1994
Original Article: PDF Only

Objective: To test the hypothesis that a very-low-dose regimen of vaginal estrogen would provide effective relief from atrophic vaginitis without endometrial proliferation.

Methods: Twenty postmenopausal women with symptoms, signs, and cytologic evidence of atrophic vaginitis were enrolled. Each subject was treated with 0.3 mg of conjugated estrogens, administered vaginally 3 nights per week for 6 months. We examined the following outcomes: symptoms, vaginal cellular (cytologic) maturity, endometrial histology, sonographic evaluation of endometrial thickness, Doppler measures of uterine artery blood flow, and serum levels of estrone and estradiol. Pre- and posttreatment data were compared for each subject.

Results: Satisfactory relief of symptoms occurred in 19 of 20 cases. Vaginal cellular maturation improved significantly with therapy (P<.01). There were no significant changes in endometrial thickness, uterine artery blood flow, or serum estrogen levels. Endometrial proliferation was observed in one case.

Conclusion: Relief from atrophic vaginitis can be achieved with 0.3 mg of conjugated estrogens administered vaginally three times per week. Endometrial proliferation may occur at this low dose, albeit rarely.

© 1994 The American College of Obstetricians and Gynecologists