The Treatment of atrophic vaginitis, which causes dry vagina, painful sex  and other local symptoms At the menopause, with Topical Estrogen.

Topical oestrogen (creams and pessaries) are commonly used in postmenopausal women to improve the quality of the vaginal epithelium in atrophic vaginitis.

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 (painful sexual intercourse). Topical Estrogen or hormone replacement therapy (ERT-HRT) is the treatment of choice in postmenopausal women.⁰¹⁰¹

If genital symptoms, such as vaginal dryness, pain during lovemaking or perhaps bladder symptoms are troubling you, these could be due to reduced oestrogen levels in the tissues around the genital area. These symptoms usually respond to HRT or to topical preparations (oestrogen creams or pessaries).

On occasion, local symptoms may fail to respond to HRT anyway and additional topical oestrogen may be required.

To begin with, the creams or pessaries are introduced each night for ten days to two weeks and then reduced to a maintenance regime varying from twice weekly to perhaps no more than once each month depending on symptoms, age and response. There are a variety of topical oestrogen preparations (Table 28.1).

Estring (Pharmacia and Upjohn), a synthetic soft rubber ring which slowly releases oestradiol can be introduced into the vagina and replaced at three monthly intervals. If the uterus is still present intermittent courses of progestogen should be considered to encourage endometrial shedding (HRT and progestogen). The ring is as effective as oestrogen creams and some women find the ring more acceptable.

 

Table 28.1 Topical creams and pessaries that are commonly used in menopause treatment.

Preparation	Oestrogen	Company
Ortho-Gynest Pessaries	Oestriol 500 g	Janssen-Cilag
Ortho-Gynest Cream	Oestriol  0.01%	Janssen-Cilag
Ovestin Cream	Oestriol 0.1%	Organon
Ovestin Pessaries	Oestradiol 1mg	Organon
Premarin  Cream	Conjugated oestrogens 625 mg	Wyeth
Vagifem Pessaries	Oestradiol 25 microg	Novo Nordisk
Estring Ring	Oestradiol (7.5 microg release/day)	Pharmacia and Upjohn

Local oestrogen for vaginal atrophy in postmenopausal women. (2006-01)

Local estrogen replacement therapy in postmenopausal atrophic vaginitis: efficacy and safety of low dose 17beta-estradiol vaginal tablets. (2005-01)

Endometrial and vaginal effects of low-dose estradiol delivered by vaginal ring or vaginal tablet. (2005-02)

Local oestrogen for vaginal atrophy in postmenopausal women. (2003-01)

Action of 25 microg 17beta-oestradiol vaginal tablets in the treatment of vaginal atrophy in Greek postmenopausal women; clinical study. (2003-02)

Urogenital atrophy: prevention and treatment.(2001-01)

17beta-estradiol vaginal tablet versus conjugated e quine estrogen vaginal cream to relieve menopausal atrophic vaginitis. (2000-01)

A comparative study of safety and efficacy of continuous low dose oestradiol released from a vaginal ring compared with conjugated e quine oestrogen vaginal cream in the treatment of postmenopausal urogenital atrophy (1996)

Restoration of vaginal ph - Rephresh

Please see Rephresh

See Also

Premarin Cream

Vagifem

 

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