A common symptom of the menopause is vaginal dryness that can severely affect a woman’s sex life. At present, many women shun hormone replacement therapy (HRT) because they fear the possible increased risk of breast cancer or cardiovascular diseases. Two new studies, both published in the January edition of the journal Menopause, report that low doses of estrogen applied vaginally can resolve vaginal dryness without significantly increasing serum estrogen levels.
The authors of the first study note that in the years following the 2002 publication of results from the Women’s Health Initiative study, many physicians have a reluctance to prescribe HRT therapy to postmenopausal women and are unclear regarding the duration and method of prescription. The main concerns are the risks of cardiovascular events and breast cancer; however, however, local vaginal estrogen may provide benefits without systemic effects.
The investigators evaluated the use and effects of vaginal estrogen on quality of life and genitourinary problems (e.g., bladder infections) among women who stopped hormone therapy after the Women’s Health Initiative and compares them to women who continued HRT. Three groups of women were compared: Group 1, women who remained on HRT; Group 2, women who resumed HRT after stopping for at leastsix6 months; and Group 3, women who stopped HRT and did not resume it.
The researchers found that, overall, ever use and present use of vaginal estrogen were most common among women who reported dyspareunia (painful intercourse) and vaginal dryness. Vaginal estrogen use was significantly more likely among women in Group 3 than for women in the other groups: Group 3 (3.5%) vs. Group 1 (17.7%) and Group 2 (16.7%). Women in Group 3 who used vaginal estrogen reported significantly higher sexual quality of life (measured by the sexual domain of the Utian Quality of Life Scale) compared to women in Group 3 who did not use vaginal estrogen. There was no difference in the incidence of urinary tract infections between the three groups (Group 1, 22.9%; Group 2, 26.3%; Group 3, 25.5%). The percentage of women who were either married or living in a marriage-like relationship did not differ between the three groups (Group 1, 68.4%; Group 2, 78.6%; Group 3, 78.8%).
The authors concluded that women who report dyspareunia and vaginal dryness are more likely to use vaginal estrogen. Women who do not use systemic HRT but use vaginal estrogen score significantly higher on the sexual quality-of-life scale than women not using vaginal estrogen.
The objective of the second study was to evaluate the sexual function and quality of life of naturally postmenopausal women affected by genitourinary problems of menopause who were treated with an ultralow-concentration estriol vaginal gel (0.005%). Postmenopausal women with vulvovaginal atrophy (thinning of vulvar and vaginal tissues) symptoms and sexual disorders were enrolled in the study. Women were treated with vaginal gel (containing 50 μg of estriol) daily for 3 weeks and then twice weekly for up to 12 weeks. The investigators conducted determination of vaginal maturation index, evaluation of vaginal pH, and assessment of vaginal atrophy symptoms. Quality of life, sexual function, and distress were assessed using the Short Form 36, Female Sexual Function Index, and Female Sexual Distress Scale questionnaires. Changes between baseline and week 12 were evaluated.
A total of 68 women were included in the study group, and 42 women were included in the control group. The women using estriol vaginal gel had a significant increase in vaginal maturation index and improvement of vaginal pH compared to baseline. The average total Female Sexual Function Index score improved, and Female Sexual Distress Scale score decreased from baseline to follow-up. Results from the Short Form 36 questionnaire showed a significant improvement in the overall index of somatic aspects (body image). The control group showed no changes from baseline evaluation.
The authors concluded that estriol vaginal gel (0.005%) therapy significantly improves the condition of the vaginal mucosa, the sexual health, and quality of life of naturally postmenopausal women. They added that their results confirmed that low doses of vaginal estrogen must be considered as the first choice for the initial treatment of postmenopausal genitourinary symptoms.