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.