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Evidence Summary

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In women who have genitourinary syndrome of menopause, vaginal estrogens reduce symptoms and do not cause side effects

Rahn DD, Carberry C, Sanses TV, et al. Vaginal estrogen for genitourinary syndrome of menopause: a systematic review. Obstet Gynecol. 2014;124:1147-56.

Review questions

In postmenopausal women who have genitourinary syndrome of menopause, do vaginal estrogens reduce symptoms? Do they cause side effects?

Background

Genitourinary syndrome of menopause is a group of signs and symptoms that can affect the genital system (vaginal dryness or burning, and pain during sexual intercourse) and the lower urinary tract (increased frequency of urination, urgency to urinate, and pain while urinating). About half of postmenopausal women experience genitourinary syndrome, which does not improve without treatment.

How the review was done

The researchers did a systematic review of studies that were published up to April 2013.

They found 44 studies.

Key features of the studies were:

  • the treatment was vaginal estrogen delivered by tablet, cream, gel, ring, ovule, or suppository;
  • vaginal estrogen was compared with placebo or no treatment (14 studies with 4,232 women), another vaginal estrogen, systemic estrogen, nonhormonal moisturizer or lubricant, or other treatments; and
  • studies were 1 month to 1 year long.

What the researchers found

The quality of evidence varied. Findings for comparisons and outcomes that are based on moderate-strength evidence are reported here. Evidence of poor, low, or very low-quality is not reported here.

Compared with placebo or no treatment, vaginal estrogen:

  • reduced the frequency of urinary tract infections;
  • reduced vaginal dryness, itching or burning, and painful intercourse;
  • reduced urinary incontinence; and
  • did not increase risk for side effects.

Conclusion

In women who have genitourinary syndrome of menopause, vaginal estrogens reduce symptoms and do not cause side effects.

Effects of vaginal estrogen compared with placebo or no treatment on genitourinary syndrome symptoms in menopausal women

Outcomes

Effects of vaginal estrogen

Urinary tract infection

4 studies found that frequency of urinary tract infections was decreased with estrogen

Vaginal dryness, itching or burning, and painful intercourse

9 studies found that dryness improved with estrogen (2 found it did not)

6 studies found that itching or burning improved with estrogen (5 found it did not)

9 studies found that painful intercourse improved with estrogen (1 found it did not)

Urgency urinary incontinence

3 studies found that urgency urinary incontinence improved with estrogen

Side events

13 trials reported no difference in adverse events between women treated with estrogen and women treated with placebo

This Table Includes evidence of moderate quality (evidence of poor, low, or very low-quality is not reported here.




Glossary

Placebo
A harmless, inactive, and simulated treatment.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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