Local oestrogen a treatment option for vaginal atrophy

Clinical question: 
Should I prescribe local oestrogen for postmenopausal women with vaginal atrophy?
Bottom line: 
Oestrogen creams, pessaries, tablets and the oestradiol vaginal ring are equally effective for relieving the symptoms of vaginal atrophy and are more effective than placebo and non-hormonal gels. However, women seem to favour the oestradiol vaginal ring for ease of use, comfort and overall satisfaction.
Caveat: 
Conjugated equine oestrogen cream is more likely than oestradiol tablets to cause uterine bleeding, breast pain and perineal pain (NNH*10). Compared to the oestradiol ring this cream is also more likely to cause endometrial overstimulation (NNH 14). * NNH = number needed to treat to cause harm in one individual
Context: 
Vaginal atrophy is a common condition in postmenopausal women, causing vaginal dryness, itching, discomfort and dyspareunia. Systemic treatment in the form of oral hormone replacement therapy is not always necessary – several local oestrogen preparations are available.
Review CD#: 
CD001500
PEARLS No: 
4
Date: 
July, 2007
Authored by: 
Brian R McAvoy
File: