Local estrogen treatment in patients with urogenital symptoms.
OBJECTIVE
Determination of the efficacy and safety of vaginally administered low dose (25 microg) micronized 17beta-estradiol in the management of patients with urogenital symptoms.


METHODS
A total of 1612 patients with urogenital complaints were randomized to receive 25 microg of micronized 17beta-estradiol (n=828) or placebo (n=784) in a multicenter double-blind placebo-controlled study running for 12 months. Female patients were treated once a day over a period of 2 weeks, and then twice a week for the remaining of the 12 months with an active or placebo tablet. The assessment included full history-questionnaire, micturition diary, gynecologic and cystometric examination, transvaginal ultrasound, and serum 17beta-estradiol level determination. It was carried out at the beginning, and after 4 and 12 months of treatment.


RESULTS
The overall success rate of micronized 17beta-estradiol and placebo on subjective and objective symptoms of postmenopausal women with vaginal atrophy was 85.5%, and 41.4%, respectively. A significant improvement of urinary atrophy symptoms was determined in vaginal ERT group as compared with the beginning of the study (51.9% vs. 15.5%, P=0.001). The maximal cystometric capacity (290 ml vs. 200 ml, P=0.023), the volume of the urinary bladder at which patients first felt urgency (180 vs. 140, P=0.048), and strong desire to void (170 ml vs. 130 ml, P=0.045) were significantly increased subsequent to the micronized 17beta-estradiol treatment. The number of patients with uninhibited bladder contractions significantly decreased following micronized 17beta-estradiol as compared with pretreatment values (17/30, P=0.013). Side effects were observed in 61 (7.8%) patients treated with low dose micronized 17beta-estradiol. Therapy with 25 microg of micronized 17beta-estradiol did not raise serum estrogen level nor stimulated endometrial growth.


CONCLUSIONS
Local administration of 25 microg of micronized 17beta-estradiol is an effective and a safe treatment option in the management of women with urogenital complaints.
Simunić
V
V
Human Reproduction Unit, Department of Gynecology and Obstetrics, Zagreb, University Hospital Center, Zagreb, Croatia.
Banović
I
I
Ciglar
S
S
Jeren
L
L
Pavicić Baldani
D
D
Sprem
M
M
D000282:Administration, Intravaginal; D001284:Atrophy; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004958:Estradiol / Q000008:administration & dosage* / Q000009:adverse effects* / Q000097:blood; D015914:Estrogen Replacement Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008487:Medical History Taking; D008875:Middle Aged; D017698:Postmenopause; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014566:Urogenital System / Q000187:drug effects; D014621:Vagina / Q000187:drug effects* / Q000473:pathology*; D014623:Vaginal Diseases / Q000188:drug therapy* / Q000473:pathology
D004958:Estradiol