title: Use of vaginal estrogen in Danish women: a nationwide cross-sectional study.
abstract: BACKGROUND
  We know little about the use of vaginal estrogen in perimenopausal and postmenopausal women. We aimed to assess the prevalence of vaginal estrogen use in Denmark.
  
  
  METHODS
  The study was designed as a nationwide cross-sectional study of all Danish women aged 40-79 years, living in Denmark during the period 2007-2013. The Danish Prescription Register delivered data permitting us to assess the prevalence, age and regional geographical belonging of women purchasing prescribed vaginal estradiol. The number of women using over-the-counter vaginal estriol products was estimated from sale statistics from the same register.
  
  
  RESULTS
  In 2013, 10.2% of all Danish women between 40 and 79 years of age used vaginal estradiol. The prevalence of women using this type of vaginal estrogen increased from 8.5% in year 2007 to 10.2% in 2013. The use peaked at 16.5% in women aged 60-74 years. The vaginal tablet was purchased more than the vaginal ring. We found no relevant difference in use between the five regions of Denmark. Taking the sale of vaginal estriol into account, the prevalence of vaginal estrogen use in 2013 could be estimated to a total of 12.1%.
  
  
  CONCLUSIONS
  Comparing our result to the prevalence of urogenital atrophy-related symptoms reported in the literature, our study suggests an under-diagnosis and under-treatment of this condition. Teaching women and primary-care physicians about symptomatic urogenital atrophy and its treatment options may increase the quality of life for many women.
authors.affiliation: Department of Gynecology, Rigshospitalet University Hospital, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark.|Furesoe Gynecological Clinic, Vaerloese, Denmark.
authors.forename: Amani
authors.identifier: http://orcid.org/0000-0003-4549-8271
authors.initials: A
authors.lastname: Meaidi
authors.affiliation: Furesoe Gynecological Clinic, Vaerloese, Denmark.
authors.forename: Irina
authors.identifier: http://orcid.org/0000-0002-9265-1964
authors.initials: I
authors.lastname: Goukasian
authors.affiliation: Department of Gynecology, Rigshospitalet University Hospital, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Oejvind
authors.identifier: http://orcid.org/0000-0002-9157-4004
authors.initials: O
authors.lastname: Lidegaard
mesh_terms: D000282:Administration, Intravaginal; D000328:Adult; D000367:Age Factors; D000368:Aged; D001284:Atrophy / Q000188:drug therapy / Q000517:prevention & control; D003430:Cross-Sectional Studies; D003718:Denmark; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004958:Estradiol / Q000627:therapeutic use*; D004964:Estriol / Q000627:therapeutic use*; D004967:Estrogens / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008875:Middle Aged; D004366:Nonprescription Drugs / Q000627:therapeutic use; D047648:Perimenopause; D017698:Postmenopause; D012042:Registries / Q000706:statistics & numerical data; D014566:Urogenital System / Q000473:pathology*
chemical_list: D004967:Estrogens; D004366:Nonprescription Drugs; D004958:Estradiol; D004964:Estriol
keywords: Estrogen therapy; female urogenital disease; genitourinary syndrome of menopause; hormone therapy; local estrogen therapy