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Tuesday, April 26, 2016

Top Form Tuesday: Comparing Estrogen Treatments For Vaginal Symptoms

Women who report vaginal symptoms, particularly pain with intercourse have been  turn to estrogen. But many estrogens are available, and women, with guidance from their gynos, after they decide if they are ever going to use estrogen, the question is what type. The vaginal symptoms formerly termed Vulvovaginal Atrophy  (VVA) and now called The Genitourinary Syndrome of Menopause have a variety of therapies that can treat the symptoms. Traditionally, when medication has been called for women were given an estrogen. The Society of Gynecologic Surgeons Systemic Review Group , which issues opinions on a variety of topics important to your gyno has undertaken a review of vaginal estrogen based on studies that included estrogen, placebo, no treatment, moisturizers, and lubricants. They did not include comparisons to the SERM medication of Osphena which is not vaginal, but offers significant additional health benefits such as a positive effect on the bones, nor did they review non-medical CO2 laser therapy MonaLisa Touch which has begun to revolutionize vaginal treatment for women. The symptoms the estrogen was treating include burning, painful sex, dryness, painful or uncomfortable urination, going to urinate frequently feeling urgency, and in some cases unusual discharge. This condition is chronic. The genitourinay syndrome with the vaginal symptoms of menopause will continue to progress and worsen as a woman ages, and even if treated will revert if the therapy is stopped. The basic conclusion was that each of the estrogens were very similar to each other formula. Interestingly some of the studies also included pelvic floor muscle therapy WITH the estrogen, so it's important for women to understand that they need individual consultation, not just a prescription, to get their best results. Also importantly, their review underscored that in these studies the safety of vaginal estrogen was mostly, but not yet conclusively, confirmed. There were no cases of blood clots ( thromboembolism) or breast cancer, but there is not enough data to say whether there is risk to the lining of the uterus or risk of uterine cancer. It was not clear whether vaginal estrogen would be able to help prevent UTIs, but the authors of this review presented in OBSTETRICS and GYNECOLOGY did point out that estrogen treatment is still considered recommended for women in menopause who have recurrent urinary tract infections.  The researchers did not look at compounded or herbal therapy, and thus these conclusions cannot be extrapolated to those treatments.

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