Summary

Urogenital atrophy is more common than it would first appear and women do not always seek advice and guidance. Confusion still exists between systemic hormone replacement therapy (HRT) and local estrogen preparations but new treatment modalities have emerged that extend the range of options beyond lubricants, moisturisers and vaginal estrogen preparations.

Practice points

  • Urogenital atrophy is common but usually under-recognised and under-reported and certainly in this country, the uptake of treatment is low.
  • Women are sexually active longer now than in previous generations and are vocal in requesting a quality of life.
  • Treatment should be continued to maintain benefits and once stopped, there will be a gradual resurgence of atrophic symptoms which may be purely vaginal, urinary or a combination.
  • All local estrogen preparations are effective and therefore a patient’s preference should be considered to maintain compliance.
  • Progestogen is not indicated for endometrial protection and local estrogen treatment is regarded safe in terms of venous thromboembolism and cancer risk.
  • Vaginal moisturisers and lubricants can be used in conjunction with topical estrogen or alone in cases where there is a medical contraindication to local treatment. Newer treatment modalities are becoming available but robust data is limited and evaluation is in its infancy.
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Reviewed: June 2018
Next review date: June 2021