Local estrogen treatment in patients with urogenital symptoms

Abstract

Local administration of 25 microg of micronized 17beta-estradiol is an effective and a safe treatment option in the management of women with urogenital complaints.

Sexual Pain Disorders: Dyspareunia and Vaginismus

“…[36]. Post coital-cystitis should suggest a hypoestrogenic condition and/or the presence of hypertonic pelvic floor muscles: it should specifically be investigated in post-menopausal women who may benefit from topical estrogen treatment [37] and rehabilitation of the pelvic floor, aimed at relaxing the myalgic perivaginal muscles [28][29][30]. Vulvar pruritus, vulvar dryness and/or feeling of a burning vulva should be investigated, as they may suggest the presence of vulvar lichen sclerosus, which may worsen introital dyspareunia [19].…”

“…• Topical hormones Vaginal estrogen treatment is the first choice (when no contraindications are present) when dyspareunia is associated with genital arousal disorders and hypoestrogenism [16][17][18][19]37] (see also the sub-chapter on arousal disorders). This biological contributor of dyspareunia in long lasting hypothalamic amenorrhea, puerperium, and postmenopause can be easily improved with this topical treatment [16][17][18][19]37].…”

“…This biological contributor of dyspareunia in long lasting hypothalamic amenorrhea, puerperium, and postmenopause can be easily improved with this topical treatment [16][17][18][19]37]. Safety of hormonal topical treatment is discussed in the sub-chapter on Hormonal Therapy.…”

Hormonal Therapy after Menopause

“…To place the above in perspective, the increased risk of diagnosis of breast cancer with HT is similar to the increased risk of it with such factors as an early menarche (before age 11 years), a late first pregnancy (over 35), nulliparity and moderate alcohol consumption (>20g/day). The increased risk attributed to HT is much less than that associated with obesity [36]. Due to the risk of recurrence, HT should not be prescribed to women with previous breast cancer (Grade B recommendation) [12].…”

The Immediate Effect of Castration on Female Rabbit Bladder Blood Flow and Tissue Oxygenation

“…In humans, the decreased estrogen level seen after menopause has been shown to induce atrophy throughout the urogenital tract and is associated with symptoms such as frequency, urgency, and nocturia and may play a role in incontinence and urinary tract infections [9,10] . Estrogen replacement therapy reverses these physiological effects.…”