Postmenopausal women who suffer from painful intercourse and vaginal dryness are more likely to use vaginal estrogen, regardless of whether they use any other type of hormone therapy, and those who do score significantly higher on the sexual quality-of-life scale than those who do not, according to study results published in Menopause: The Journal of The North American Menopause Society.
Prathima Setty, MD, an obstetrician-gynecologist, and colleagues sought to examine whether vaginal estrogen still represents a viable solution for a subset of women with urogenital problems who discontinued hormone therapy (HT) after a 2002 Women's Health Initiative Study (WHI) raised concerns about its safety.
In the years after the WHI study's publication, HT prescriptions and usage had dropped, largely due to concerns of increased risk for cardiovascular events and breast cancer. However, after women discontinued the use of HT, there remained a need to effectively treat them for various menopausal symptoms.
Among the 310 New York women participated in the Menopause study, it appears that vaginal estrogen offers a number of benefits without creating additional medical concerns. Even more interesting is that the study suggests a need, in certain circumstances, to add local vaginal estrogen even for women already being treated with systemic hormones.
The researchers compared the use and effects of vaginal estrogen on quality of life and urogential morbidity among women who continued HT after the WHI study (group 1), those who resumed HT/estrogen therapy after stopping for at least 6 months (group 2), and those who stopped HT and had not resumed (group 3).
Those in group 3 who resumed vaginal estrogen reported significantly higher sexual quality of life on the Utian Quality of Life Scale compared with those in group 3 who did not (P=.007), the researchers found.
There were no differences in incidence of urinary tract infections between the 3 groups (group 1, 22.9%; group 2, 26.3%; group 3, 25.5%.
The most common urogenital symptom associated with menopause is dryness, followed by irritation or itching, discharge, and dysuria. These symptoms are the result of vulvovaginal atrophy that occurs with the absence of estrogen.
"We know that estrogens play a key role in maintaining vaginal health," said Wulf Utian, MD, PhD, DSc, the founder and executive director of the The North American Menopause Society (NAMS). "Not only do they assist with lubrication, but some studies also show them to be effective in preventing urinary tract infections. That's why women need to have more estrogen options and be educated on their benefits and potential risks."
In the years after the 2002 publication of results from the Women’s Health Initiative study, there has been a reluctance to prescribe hormone therapy to symptomatic postmenopausal women and confusion over its duration and method of prescription. The main concerns are the risks of cardiovascular events and breast cancer. However, local vaginal estrogen (VE) may provide benefits without systemic effects.