Vaginal estrogen for genitourinary syndrome of menopause
Vaginal problems are common in menopause, and that includes bladder and urinary symptoms. The fact is that both the bladder and vagina thrive under the influence of oestrogen, and so oestrogen is essential for both vagina and bladder health. Unfortunately, too many women suffer in silence over menopausal vaginal problems and do not discuss it with their doctors.
Vaginal estrogen for genitourinary syndrome of menopause: A systematic review
Obstetrics and Gynecology, 12/05/2014 Evidence Based Medicine Review Article
Rahn DD, et al. – In this study, authors want to comprehensively review and critically assess the literature on vaginal estrogen and its alternatives for women with genitourinary syndrome of menopause and to provide clinical practice guidelines. All commercially available vaginal estrogens effectively relieve common vulvovaginal atrophy–related complaints and have additional utility in patients with urinary urgency, frequency or nocturia, SUI and UUI, and recurrent UTIs. Nonhormonal moisturizers are a beneficial alternative for those with few or minor atrophy–related symptoms and in patients at risk for estrogen–related neoplasia.
- MEDLINE and Cochrane databases were searched from inception to April 2013.
- Authors included randomized controlled trials and prospective comparative studies.
- Interventions and comparators included all commercially available vaginal estrogen products.
- Placebo, no treatment, systemic estrogen (all routes), and nonhormonal moisturizers and lubricants were included as comparators.
- Authors double–screened 1,805 s, identifying 44 eligible studies.
- Discrepancies were adjudicated by a third reviewer.
- Studies were individually and collectively assessed for methodologic quality and strength of evidence.
- Studies were extracted for participant, intervention, comparator, and outcomes data, including patient–reported atrophy symptoms (eg, vaginal dryness, dyspareunia, dysuria, urgency, frequency, recurrent urinary tract infection (UTI), and urinary incontinence), objective signs of atrophy, urodynamic measures, endometrial effects, serum estradiol changes, and adverse events.
- Compared with placebo, vaginal estrogens improved dryness, dyspareunia, urinary urgency, frequency, and stress urinary incontinence (SUI) and urgency urinary incontinence (UUI).
- Urinary tract infection rates decreased.
- The various estrogen preparations had similar efficacy and safety; serum estradiol levels remained within postmenopausal norms for all except high–dose conjugated equine estrogen cream.
- Endometrial hyperplasia and adenocarcinoma were extremely rare among those receiving vaginal estrogen.
- Comparing vaginal estrogen with nonhormonal moisturizers, patients with two or more symptoms of vulvovaginal atrophy were substantially more improved using vaginal estrogens, but those with one or minor complaints had similar symptom resolution with either estrogen or nonhormonal moisturizer.