Vaginal estrogen preparations: a review of safety and efficacy for vaginal atrophy.
BACKGROUND
A theoretical advantage of local (i.e., vaginal) therapy of genitourinary symptoms could be avoidance of systemic adverse effects. Review of efficacy and adverse effects of commonly prescribed vaginal estrogens is of great clinical relevance.


METHODS
A Medline (1966-present) search was performed for randomized controlled trials involving vaginal estrogens. Reference lists of papers were reviewed for additional references.


RESULTS
Twenty-two references were randomized controlled trials of vaginal estrogens used by postmenopausal women with signs or symptoms of vaginal atrophy. Subject numbers ranged from 20 to 251. Duration ranged from 2 weeks to 1 year. Different preparations and schedules were used across the trials. All treatments alleviated signs and symptoms of atrophic vaginitis, regardless of whether objective signs of atrophy were required for study entry. Data for urinary symptoms was conflicting; the ring may prevent recurrent urinary tract infections (UTIs). The trials with endometrial scrutiny were less than one year and had mixed results. Nonhormonal lubricant is effective in improving some atrophic signs and symptoms. All preparations were associated with vaginal irritation. Bleeding with vaginal estradiol tablets may be less than that with CEE cream. Vaginal tablets or rings were preferred over other preparations. There were no serious adverse events reported. There was occasional expulsion of estradiol ring in the setting of prior hysterectomy.


CONCLUSIONS
All preparations are effective in decreasing signs and symptoms of vaginal atrophy, but they differ slightly in their adverse event profiles. Long-term safety of the preparations is best established for estradiol tablets (1 year), but is lacking for all preparations.
Crandall
Carolyn
C
Department of Medicine, UCLA School of Medicine, Iris Cantor-UCLA Women's Health Center, Los Angeles, California 90095-7023, USA. ccrandrall@mednet.ucla.edu
D000282:Administration, Intravaginal; D001284:Atrophy / Q000188:drug therapy; D016503:Drug Delivery Systems; D004958:Estradiol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D010570:Pessaries; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014621:Vagina / Q000187:drug effects / Q000473:pathology*; D014622:Vaginal Creams, Foams, and Jellies / Q000008:administration & dosage; D014623:Vaginal Diseases / Q000188:drug therapy*
D014622:Vaginal Creams, Foams, and Jellies; D004958:Estradiol