Vaginal estrogen for genitourinary syndrome of menopause

Society of Gynecologic Surgeons Systematic Review Group

Research output: Contribution to journalArticle

98 Citations (Scopus)

Abstract

DATA SOURCES: MEDLINE and Cochrane databases were searched from inception to April 2013. We included randomized controlled trials and prospective comparative studies. Interventions and comparators included all commercially available vaginal estrogen products. Placebo, no treatment, systemic estrogen (all routes), and nonhormonal moisturizers and lubricants were included as comparators.

METHODS OF STUDY SELECTION: We double-screened 1,805 abstracts, identifying 44 eligible studies. Discrepancies were adjudicated by a third reviewer. Studies were individually and collectively assessed for methodologic quality and strength of evidence.

OBJECTIVE: To comprehensively review and critically assess the literature on vaginal estrogen and its alternatives for women with genitourinary syndrome of menopause and to provide clinical practice guidelines.

TABULATION, INTEGRATION, AND RESULTS: Studies were extracted for participant, intervention, comparator, and outcomes data, including patient-reported atrophy symptoms (eg, vaginal dryness, dyspareunia, dysuria, urgency, frequency, recurrent urinary tract infection (UTI), and urinary incontinence), objective signs of atrophy, urodynamic measures, endometrial effects, serum estradiol changes, and adverse events. Compared with placebo, vaginal estrogens improved dryness, dyspareunia, urinary urgency, frequency, and stress urinary incontinence (SUI) and urgency urinary incontinence (UUI). Urinary tract infection rates decreased. The various estrogen preparations had similar efficacy and safety; serum estradiol levels remained within postmenopausal norms for all except high-dose conjugated equine estrogen cream. Endometrial hyperplasia and adenocarcinoma were extremely rare among those receiving vaginal estrogen. Comparing vaginal estrogen with nonhormonal moisturizers, patients with two or more symptoms of vulvovaginal atrophy were substantially more improved using vaginal estrogens, but those with one or minor complaints had similar symptom resolution with either estrogen or nonhormonal moisturizer.

CONCLUSION: All commercially available vaginal estrogens effectively relieve common vulvovaginal atrophyrelated complaints and have additional utility in patients with urinary urgency, frequency or nocturia, SUI and UUI, and recurrent UTIs. Nonhormonal moisturizers are a beneficial alternative for those with few or minor atrophy-related symptoms and in patients at risk for estrogen-related neoplasia.

Original languageEnglish (US)
Pages (from-to)1147-1156
Number of pages10
JournalObstetrics and Gynecology
Volume124
Issue number6
DOIs
StatePublished - Dec 11 2014

Fingerprint

Menopause
Estrogens
Atrophy
Urinary Incontinence
Dyspareunia
Stress Urinary Incontinence
Urinary Tract Infections
Estradiol
Placebos
Nocturia
Endometrial Hyperplasia
Conjugated (USP) Estrogens
Lubricants
Dysuria
Urodynamics
Serum
Practice Guidelines
MEDLINE
Adenocarcinoma
Randomized Controlled Trials

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Medicine(all)

Cite this

Society of Gynecologic Surgeons Systematic Review Group (2014). Vaginal estrogen for genitourinary syndrome of menopause. Obstetrics and Gynecology, 124(6), 1147-1156. https://doi.org/10.1097/AOG.0000000000000526

Vaginal estrogen for genitourinary syndrome of menopause. / Society of Gynecologic Surgeons Systematic Review Group.

In: Obstetrics and Gynecology, Vol. 124, No. 6, 11.12.2014, p. 1147-1156.

Research output: Contribution to journalArticle

Society of Gynecologic Surgeons Systematic Review Group 2014, 'Vaginal estrogen for genitourinary syndrome of menopause', Obstetrics and Gynecology, vol. 124, no. 6, pp. 1147-1156. https://doi.org/10.1097/AOG.0000000000000526
Society of Gynecologic Surgeons Systematic Review Group. Vaginal estrogen for genitourinary syndrome of menopause. Obstetrics and Gynecology. 2014 Dec 11;124(6):1147-1156. https://doi.org/10.1097/AOG.0000000000000526
Society of Gynecologic Surgeons Systematic Review Group. / Vaginal estrogen for genitourinary syndrome of menopause. In: Obstetrics and Gynecology. 2014 ; Vol. 124, No. 6. pp. 1147-1156.
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abstract = "DATA SOURCES: MEDLINE and Cochrane databases were searched from inception to April 2013. We included randomized controlled trials and prospective comparative studies. Interventions and comparators included all commercially available vaginal estrogen products. Placebo, no treatment, systemic estrogen (all routes), and nonhormonal moisturizers and lubricants were included as comparators.METHODS OF STUDY SELECTION: We double-screened 1,805 abstracts, identifying 44 eligible studies. Discrepancies were adjudicated by a third reviewer. Studies were individually and collectively assessed for methodologic quality and strength of evidence.OBJECTIVE: To comprehensively review and critically assess the literature on vaginal estrogen and its alternatives for women with genitourinary syndrome of menopause and to provide clinical practice guidelines.TABULATION, INTEGRATION, AND RESULTS: Studies were extracted for participant, intervention, comparator, and outcomes data, including patient-reported atrophy symptoms (eg, vaginal dryness, dyspareunia, dysuria, urgency, frequency, recurrent urinary tract infection (UTI), and urinary incontinence), objective signs of atrophy, urodynamic measures, endometrial effects, serum estradiol changes, and adverse events. Compared with placebo, vaginal estrogens improved dryness, dyspareunia, urinary urgency, frequency, and stress urinary incontinence (SUI) and urgency urinary incontinence (UUI). Urinary tract infection rates decreased. The various estrogen preparations had similar efficacy and safety; serum estradiol levels remained within postmenopausal norms for all except high-dose conjugated equine estrogen cream. Endometrial hyperplasia and adenocarcinoma were extremely rare among those receiving vaginal estrogen. Comparing vaginal estrogen with nonhormonal moisturizers, patients with two or more symptoms of vulvovaginal atrophy were substantially more improved using vaginal estrogens, but those with one or minor complaints had similar symptom resolution with either estrogen or nonhormonal moisturizer.CONCLUSION: All commercially available vaginal estrogens effectively relieve common vulvovaginal atrophyrelated complaints and have additional utility in patients with urinary urgency, frequency or nocturia, SUI and UUI, and recurrent UTIs. Nonhormonal moisturizers are a beneficial alternative for those with few or minor atrophy-related symptoms and in patients at risk for estrogen-related neoplasia.",
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