The role of local vaginal estrogen for treatment of vaginal atrophy in postmenopausal women: 2007 position statement of The North American Menopause Society

Menopause. May-Jun 2007;14(3 Pt 1):355-69; quiz 370-1. doi: 10.1097/gme.0b013e31805170eb.

Abstract

Objective: To create an evidence-based position statement published by The North American Menopause Society (NAMS) on the role of local vaginal estrogen therapy (ET) for the treatment of vaginal atrophy in postmenopausal women.

Design: NAMS followed the general principles established for evidence-based guidelines to create this document. A panel of clinicians and researchers acknowledged to be experts in the field of genitourinary disease was enlisted to review, synthesize, and interpret the current evidence on vaginal ET for vaginal atrophy, develop conclusions, and make recommendations. Their advice was used to assist the NAMS Board of Trustees in publishing this position statement.

Results: Randomized controlled trials, albeit limited, have shown that low-dose, local vaginal estrogen delivery is effective and well tolerated for treating vaginal atrophy. All of the low-dose vaginal estrogen products approved in the United States for treatment of vaginal atrophy are equally effective at the doses recommended in labeling.

Conclusions: The choice of therapy should be guided by clinical experience and patient preference. Progestogen is generally not indicated when low-dose estrogen is administered locally for vaginal atrophy. Data are insufficient to recommend annual endometrial surveillance in asymptomatic women using vaginal ET. Vaginal ET should be continued for women as long as distressful symptoms remain. For women treated for non-hormone-dependent cancer, management of vaginal atrophy is similar to that for women without a cancer history. For women with a history of hormone-dependent cancer, management recommendations are dependent upon each woman's preference in consultation with her oncologist.

Publication types

  • Consensus Development Conference
  • Practice Guideline
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Intravaginal
  • Atrophy / drug therapy
  • Dyspareunia / drug therapy
  • Estrogen Replacement Therapy / methods*
  • Estrogens / therapeutic use*
  • Evidence-Based Medicine
  • Female
  • Humans
  • Postmenopause*
  • Randomized Controlled Trials as Topic
  • Sexual Dysfunction, Physiological / drug therapy
  • Societies, Medical
  • United States
  • Vagina / metabolism
  • Vagina / pathology*
  • Vaginal Creams, Foams, and Jellies / therapeutic use
  • Women's Health

Substances

  • Estrogens
  • Vaginal Creams, Foams, and Jellies