Enhancing quality of life: addressing vulvovaginal atrophy and urinary tract symptoms

About 50% of postmenopausal women experience symptoms of vulvovaginal atrophy (VVA) including vulvovaginal dryness, burning, itching and dyspareunia as a natural physiological consequence of hypoestrogenism. These symptoms can have a major impact on quality of life and sexual function. VVA is a component of genitourinary syndrome of menopause, also associated with urinary tract problems such as frequent urination, urge incontinence and recurrent urinary tract infections. Vaginal low-dose estrogen is an effective treatment for symptoms of VVA, overactive bladder and urge incontinence, and prevents recurrent urinary tract infections. In contrast, systemic menopausal hormone therapy seems to worsen urinary incontinence. Women with breast cancer treated with aromatase inhibitors often have severe symptoms of VVA and urinary tract problems. Non-hormonal lubricants and moisturizers should be the first-line treatment in these patients. However, there is no evidence of increased cancer recurrence by low-dose vaginal estrogen in breast cancer survivors. When non-hormonal products are ineffective, low-dose vaginal estrogen could be considered in collaboration with the woman's oncologist. An individualized approach is required for the management of VVA and urinary tract symptoms. As VVA is a chronic condition, women should not be denied long-term use of vaginal estrogens if the treatment is of benefit to them.