Vaginal estrogen therapy for the treatment of atrophic vaginitis

The prevalence of atrophic vaginitis (AV) is particularly high among postmenopausal women who experience decreased ovarian estrogen production. This common menopausal condition, which is often underreported and underdiagnosed, is caused by estrogen-related changes to the vaginal epithelium and can adversely affect quality of life. An accurate diagnosis of AV and its severity is important in choosing the appropriate treatment. Numerous formulations for estrogen therapy are available, and the safety and efficacy of these preparations for the treatment of AV have been evaluated in randomized controlled clinical trials. Although systemic administration of estrogen is effective in treating acute vasomotor symptoms typically associated with perimenopause and early menopause, standard doses may not be sufficient for the treatment of AV-related symptoms that generally arise after long-term estrogen deficiency. Thus, vaginal estrogen preparations (e.g., creams, tablets, rings) are more often recommended for women with moderate to severe AV. With any estrogen therapy, consideration of the potential adverse effects vs. associated benefits is necessary. Appropriate clinical intervention with vaginal estrogen formulations may safely offer postmenopausal women relief from undesirable symptoms and emotional distress associated with AV.