Vaginal Estrogen for Genitourinary Syndrome of Menopause

Introduction:
As women go through peri-menopause and menopause, estrogen levels drop in the body. Estrogen is a naturally occurring hormone which, among many other roles, supports the vaginal lining. As estrogen levels drop, the lining becomes thinner and less elastic. Genitourinary syndrome of menopause (GSM) is the medical term for the symptoms caused by menopausal vaginal changes.

Symptoms:

• vaginal dryness, burning, or itching
• pain with intercourse
• recurrent urinary tract infections
• difficulty with arousal or orgasm
• burning with urination
• urinary frequency or urgency
• urinary leakage (particularly with coughing or exercise)
• vaginal prolapse

Treatment:
Application of vaginal estrogen can help alleviate the symptoms above. This can be administered in a number of ways, including a cream, a vaginal insert/suppository, or a vaginal ring. Which method you select with your medical provider depends on your symptoms, comfort, and sometimes cost. Creams and vaginal inserts are typically used daily for two weeks followed by 2-3 times a week lifelong.

Who should not use vaginal estrogen:

• women with unexplained vaginal bleeding
• women with active vaginal, vulvar, or uterine, endometrial cancer that is estrogen sensitive

Safety profile of vaginal estrogen:
Vaginal estrogen does not significantly increase blood levels of estrogen and can be safely used in almost all women. It does not increase risk of endometrial cancer, breast cancer or blood clots according to the latest research. Guidelines support the use of vaginal estrogen in women with a history of estrogen receptor positive breast cancer.

Possible side effects of vaginal estrogen:

• mild vaginal burning or itching
• vaginal discharge
• vaginal yeast infection

Alternatives to vaginal estrogen:
Though they are not as effective as vaginal estrogen, over the counter vaginal lubricants and moisturizers are widely available. These can also be used on days when not applying vaginal estrogen. Other vaginal therapies including DHEA and laser can be used for severe dryness.