Urogenital Atrophy: Prevention and Treatment

Abstract

Fifteen percent of premenopausal women, 10-40% of postmenopausal women, and 10-25% of women receiving systemic hormone therapy experience urogenital atrophy. The most common symptoms are dryness, burning, pruritus, irritation, and dyspareunia. Estrogen loss, drugs, and chemical sensitivities are causes. Estrogen or hormone replacement therapy (ERT-HRT) is the treatment of choice in postmenopausal women. Dosages prescribed for menopause symptoms or to prevent osteoporosis (and, potentially, other conditions) can restore the vagina to premenopausal physiology and relieve symptoms. Concomitant progestins are necessary for women with an intact uterus to minimize or eliminate estrogen-induced endometrial cancer. Low-dosage oral and vaginal ERT can relieve urogenital atrophy but might not produce systemic effects. Progestins are not necessary with vaginal rings and vaginal tablets. If ERT is given only to treat urogenital atrophy, estrogen creams 1 or 2 times/week may prevent recurrence after symptoms are resolved. Progestins are not required for occasional estrogen cream use. Vaginal moisturizers provide longer relief by changing the fluid content of endothelium and lowering vaginal pH. Vaginal lubricants provide short-term relief. Women with contraindications to ERT-HRT could use lubricants for intercourse-related dryness or moisturizers for more continuous relief. The lay press promotes agrimony, black cohosh, chaste tree, dong quai, witch hazel, and phytoestrogens for vaginal dryness and dyspareunia; however, no evidence exists to support these specific claims. Pharmacists should be actively involved in identifying, preventing, and treating urogenital atrophy.

COMPARISON OF EFFECT OF RED CLOVER & CONJUGATED ESTROGEN ON MENOPAUSAL SYMPTOMS AND THEIR IMPACT ON QUALITY OF LIFE IN POSTMENOPAUSAL WOMEN

“…[ 17] In another study, a meta-analysis reviewing randomized, placebo-controlled trials published between 1969 and 1995 determined that estrogen therapy, as compared to placebo, was efficacious in the treatment of post-menopausal women with signs and symptoms of vaginal atrophy. [18] In the Women"s HOPE trial, which included a dose of 0.3 mg conjugated equine estrogens with and without medroxyprogesterone acetate at 1.5 mg /day, significant changes from baseline Vaginal Maturation Index were reported after 6 and 13 cycles respectively. [19] Woods et al, showed that the administration of red clover isoflavones, has also been correlated with a significant improvement in the vaginal maturation index.…”

Urogenitale Beschwerden und Östradioltherapie

“…Etwa 10-40% der postmenopausalen Frau en leiden an urogenitaler Atrophie [1]. Mit zunehmendem Alter steigt der Anteil der Frauen mit vaginalen Beschwerden wie Scheidentrockenheit, Juckreiz und Dys pareunie an.…”

“…Östrogene sind die Therapie der Wahl bei urogenitaler Atrophie in der Postmeno pause [1]. Für alternative Therapien (homöo pathische Arzneimittel und Phytopharma ka) konnte bisher kein Sicherheits und Wirksamkeitsnachweis in Form von rando misierten, doppelblinden und placebokon trollierten Studien erbracht werden [9].…”

Perceived Efficacy of Vaginal Dryness Relief: A Comparative Clinical Study between <i>Sodium hyaluronate vaginal gel</i><sup>1</sup> <i>vs. Promestriene cream</i><sup>2</sup>

“…The epidemiologic data on post-menopause women evolution confirm that only 25.0% of them refer for treatment [6] [7] [8]. So, these events have a significant impact on women's quality of life [9] [10].…”