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Efficacy and tolerability of local estrogen therapy for urogenital atrophy

Archer, David F. MD

doi: 10.1097/gme.0b013e3181a95581
Review Articles

Objective: This study aimed to identify vaginal discomfort in the form of dryness, itching, burning, and dyspareunia, which remains an inadequately addressed clinical problem for many postmenopausal women, and to describe the age or menopause-related dysfunction of the female urethral tract, which is prevalent.

Methods: Medical literature on the incidence and treatment of vulvovaginal symptoms in postmenopausal women was reviewed.

Results: Urogenital atrophy should not be considered an inevitable consequence of menopause because various hormonal and nonhormonal products are available to relieve symptoms. Estrogen deficiency is the primary cause of atrophic urogenital changes, and postmenopausal estrogen therapy is the most logical choice for treatment. All available low-dose local estrogen formulations are effective, but the optimal dose and preferred mode of estrogen administration to achieve symptom relief can vary from woman to woman. Individualization of therapy is the key to balancing the desired local effects of topical vaginal estrogens with potential systemic effects, which may or may not be desired.

Conclusions: This article reviews the use of products for the management of urogenital atrophy in terms of their efficacy, safety, and other characteristics that may influence prescribing and woman's preference.

Symptoms of urogenital atrophy are among the most common and most overlooked symptoms of postmenopausal estrogen deficiency. Numerous low-dose local vaginal estrogen therapies that effectively treat urogenital atrophy are available, but the optimal dose, duration, and mode of delivery may vary from woman to woman.

From the CONRAD Clinical Research Center, Eastern Virginia Medical School, Norfolk, VA.

Received December 2, 2008; revised and accepted April 9, 2009.

Funding/support: This work was supported by an unrestricted grant from Novo Nordisk.

Financial disclosure/conflicts of interest: None reported.

Reprints: Not available.

Address correspondence to: David F. Archer, MD, CONRAD Clinical Research Center, Eastern Virginia Medical School, 601 Colley Ave., Norfolk, VA 23507-1912. E-mail:

©2010The North American Menopause Society