Vaginal estrogen deficiency

Abstract

Key content Vaginal estrogen deficiency occurs with declining serum estradiol levels in menopause and premature ovarian insufficiency. The symptoms most commonly involve vulval and vaginal dryness, pruritis, dyspareunia and discharge. Treatment is simple and easily accessible and can be hormonal and nonhormonal. Nonhormonal treatments are particularly helpful for women who cannot take estrogen. They include simple treatments such as local lubricants and moisturisers, and newer modalities of treatment, including laser. Vaginal estrogen is the most commonly used form of hormonal treatment. However, selective estrogen receptor modulators, tissue‐selective estrogen complexes, androgens and dehydroepiandrosterone have recently been introduced and are effective and safe. Learning objectives To understand the pathogenesis, symptoms and diagnosis of vulvovaginal atrophy. To appreciate attitudes and stances towards vulvovaginal atrophy. To understand management options for vaginal estrogen deficiency. Ethical issues The impact of vulvovaginal atrophy on the quality of life of many women is profound but underestimated. Vulvovaginal atrophy is underdiagnosed and undertreated. Considering that more women are spending a significant proportion of their lives in the postmenopausal period, understanding the diagnosis and treatment of vulvovaginal atrophy must develop in synchrony with this growing unmet need.