(HealthDay News) — All vaginal estrogens are effective for women with genitourinary syndrome of menopause, defined as vulvovaginal atrophy and other symptoms associated with a decrease in estrogen and other sex steroids, according to a review published in Obstetrics & Gynecology.

David D. Rahn, MD, from the University of Texas Southwestern Medical Center in Dallas, and colleagues conducted a systematic review to provide clinical practice guidelines relating to vaginal estrogen and its alternatives for women with genitourinary syndrome of menopause. Data were reviewed from 44 eligible studies.

The researchers found that, compared with placebo, vaginal estrogen preparations improved dryness, dyspareunia, urinary urgency and frequency, and stress and urge urinary incontinence. 

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Similar efficacy and safety was seen for the various estrogen preparations. For all except high-dose conjugated equine estrogen cream serum, estradiol levels remained within postmenopausal norms. Among those receiving vaginal estrogen, endometrial hyperplasia and adenocarcinoma were extremely rare. 

Patients with two or more symptoms of vulvovaginal atrophy experienced considerably more improvement when using vaginal estrogens than nonhormonal moisturizers, whereas similar symptom resolution was seen with vaginal estrogen and nonhormonal moisturizers for those with one or minor complaints.

“In conclusion, this systematic review of randomized trials and prospective comparative studies of vaginal estrogen and common alternative therapies confirms the efficacy of all commercially available vaginal estrogens for the management of genitourinary syndrome of menopause,” the researchers wrote.


  1. Rahn DD et al. Obstet Gynecol. 2014;doi:10.1097/AOG.0000000000000526.