Urogenital atrophy: prevention and treatment.
Willhite LA, O'Connell MB.
Pharmacy Department, Fairview University Medical Center,
University of Minnesota, Minneapolis, USA. 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.
The aim of this web site is to provide a general guide and it is not intended as a substitute for a consultation with an appropriate specialist in respect of individual care and treatment.
