“If women have only vaginal dryness or discomfort with intercourse, the preferred treatments are low doses of vaginal estrogen”.1

Umbrella
What may the Hormone Therapy and Vaginal Estrogen Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • Hormone Replacement Therapy (HRT)
  • Hormone Therapy (HT)
  • Local Low-Dose Estrogen Therapy
  • Menopausal Hormone Therapy (MHT)
  • Vaginal Estrogen/Oestrogen

Statements

What is one of the points of consensus about menopausal hormone therapy (MHT) and vaginal estrogen?

One of the points of consensus in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT – endorsed by seven menopause-related organizations – published online 20 June 2016, is:

  • “MHT, including tibolone, is effective in the treatment of vulvovaginal atrophy (VVA), now also considered as a component of the genitourinary syndrome of menopause (GSM). Local low-dose estrogen therapy is preferred for women whose symptoms are limited to vaginal dryness or associated discomfort with intercourse or for the prevention of recurrent urinary tract infections”.2

What is one of the major points of agreement about vaginal estrogen?

One of the major points of agreement in the joint statement 15 Top Medical Organizations Agree on Hormone Therapy: 10 Years Have Passed Since Women’s Health Initiative Raised Questions dated 09 July 2012, is:

  • “If women have only vaginal dryness or discomfort with intercourse, the preferred treatments are low doses of vaginal estrogen”.3

NICE Guidelines

What do the (British) National Institute for Health and Care Excellence’s (NICE) guidelines note about HT and vaginal estrogen?

In Menopause: Diagnosis and Management – Information for the Public: Managing Your Symptoms published date November 2015, the NICE note about Vaginal Dryness:

“If you have vaginal dryness you should be offered vaginal oestrogen, which is put directly into the vagina as a pessary, cream or a vaginal ring. You can use vaginal oestrogen for as long as you need to, even if you are already using HRT. Moisturisers and lubricants can also help. If vaginal oestrogen doesn’t help to start with you may be offered a higher dose. It’s rare for vaginal oestrogen to cause problems, but if you have any unexpected vaginal bleeding you should tell your GP. Your GP should explain that your symptoms may come back when you stop using it. Vaginal oestrogen might be suitable for you if you can’t take HRT for medical reasons. Your GP should check this first with a healthcare professional specialising in menopause”.4

Who is a GP?

Dots and/or DotC (Depending on the Country) a GP may be a registered general practitioner, a medical practitioner, a medical doctor or a doctor.

Cream, Tablet, Pessary or Ring

How can estrogen be applied directly to the vagina?

In Menopause Management: Managing Vaginal Problems – Dry Vaginal Treatments: Vaginal Estrogen the (Australian) Jean Hailes for Women’s Health explain:

  • “Oestrogen can be applied directly to the vagina in the form of a cream, tablet or pessary”.5

On page two in Vaginal Dryness: Vaginal Estrogen Therapy the North American Menopause Society (NAMS) elaborate on:

Hormone Therapy and Vaginal Estrogen

  • “Government-approved low-dose vaginal estrogen products are available by prescription as vaginal creams (used two or three nights/week), a vaginal estradiol tablet (used twice/week), and an estradiol vaginal ring (changed every 3 months). All are highly effective. You may wish to try several different forms and choose the one you prefer”.6

Vaginal Symptoms

Are all vaginal symptoms at this time, related to menopause?

On page two in Vaginal Dryness the NAMS note:

“Note: Vaginal symptoms not related to menopause include yeast infections, allergic reactions, and certain skin conditions, so consult your health care provider if symptoms do not improve with treatment”.7

Health Care Provider

What if I would like to use vaginal estrogen?

If you would like to use vaginal estrogen, it may be in your best interest to choose to talk to your health care provider about this.

On page one in Vaginal Dryness: Treatment Options the NAMS elaborate on:

“The good news is that effective treatment options, such as nonhormone remedies or different forms of low-dose estrogen applied directly to the vagina, are available. These can be combined for optimal symptom relief”.8

The NAMS also note:

“You should discuss your individual risks and preferences with your healthcare team to determine whether hormone therapy or alternatives, including FDA-approved nonhormonal therapies, are right for you”.9

What is FDA?

FDA can be an abbreviation for the (United States) Food and Drug Administration.

Health Topics A-Z

Where may I find Health Topics related to Hormone Therapy and Vaginal Estrogen?

In Health Topics A-you may find:

Links

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Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

Sources

  1. 15 Top Medical Organizations Agree on Hormone Therapy Use: 10 Years Have Passed Since Women’s Health Initiative Raised Questions. 09 July 2012:2. North American Menopause Society, American Society for Reproductive Medicine and the Endocrine Society https://www.menopause.org/docs/default-document-library/pr12solidarity.pdf?sfvrsn=2 Accessed: 21 May 2020
  2. De Villiers, T. J., Hall, J. E., Pinkerton, J. V., Pérez, S. C., Rees, M., Yang, C. and Pierroz, D. D. Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT. Climacteric, 2016;19:4:313 https://www.imsociety.org/manage/images/pdf/ba6379e868044bec13015ac2b84f2753.pdf Accessed: 21 May 2020
  3. 15 Top Medical Organizations Agree on Hormone Therapy Use: 10 Years Have Passed Since Women’s Health Initiative Raised Questions. 09 July 2012:2. North American Menopause Society, American Society for Reproductive Medicine and the Endocrine Society https://www.menopause.org/docs/default-document-library/pr12solidarity.pdf?sfvrsn=2 Accessed: 21 May 2020
  4. Menopause: Diagnosis and Management – Information for the Public: Managing Your Symptoms – Vaginal Dryness. Published Date: November 2015. National Institute for Health and Care Excellence  https://www.nice.org.uk/guidance/ng23/ifp/chapter/Managing-your-symptoms Accessed: 21 May 2020
  5. Menopause Management: Managing Vaginal Problems – Dry Vagina Treatments: Vaginal Oestrogen. Last Updated: 07 April 2020 | Last Reviewed: 17 December 2017. Jean Hailes https://jeanhailes.org.au/health-a-z/menopause/menopause-management Accessed: 21 May 2020
  6. Vaginal Dryness: Vaginal Estrogen Therapy. 2018: 2. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 21 May 2020
  7. Vaginal Dryness: Note. 2018: 2. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 21 May 2020
  8. Vaginal Dryness: Treatment Options. 2018: 1. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 21 May 2020
  9. Menopause FAQs: Hormone Therapy – Q. What is hormone therapy? North American Menopause Society https://www.menopause.org/for-women/menopause-faqs-hormone-therapy-for-menopause-symptoms Accessed: 21 May 2020
Topic Last Updated: 21 May 2020 – Topic Last Reviewed: 21 May 2020
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