Many menopausal women experience vulval and vaginal dryness and discomfort as a result of estrogen deficiency. This can cause significant distress and generally has been under reported and under treated; women sometimes not recognising this as a menopausal, ie hormone related condition, and can be too embarrassed to discuss this sensitive topic.

With improved understanding of consequences of menopausal estrogen deficiency, hopefully more women will seek help and consider treatment. For many years vaginal estrogen in the form of cream, vaginal tablets, or a vaginal ring has been used very effectively and long term treatment is recommended. It is believed that vaginal estrogen is minimally absorbed and so a progestogen does not need to be given in addition to vaginal estrogen to prevent estrogenic stimulation of the endometrium (womb lining), as is the case with Hprmone Repalcement Therapy.

A recent review, which included 20 randomised controlled trials of 2,983 women, showed no increase in stimulation of the endometrium and no increase in endometrial cancer with low dose preparations. Some increase was noted in older studies where higher doses tended to be used.

Limitations of the review were stated to include the limited number of studies and the varying duration of studies. However, it was felt that the collective reports showed no increased risk of endometrial thickening or endometrial cancer, consistent with current recommendations that low dose vaginal estrogen can be used without the need for additional progestogen.

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Reference: Constantine G D, Graham S, Lapane K et al. Endometrial Safety of Low-dose Vaginal Estrogens in Menopausal Women. Menopause 2019;26(7):800-807