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Vaginal atrophy

Regular and continuous mechanical stimulation of the vaginal epithelium (e. g. pessaries, intercourse) increases proliferation of the epithelium, improve atrophy and local acidity. Placebocontrolled studies demonstrate a significant additional effect of local estrogens, being the goldstandard in the treatment of urogenital atrophy. SERMs have side effects on the endometrium, Raloxifen has no or even negative effect on atrophy. Acidity-adapted lubricants improve dryness and dyspareunia, but might provoke vaginal irritation and pruritus. The potential risk of local estrogens can be reduced significantly by low-dose regimens with 10 ug estradiol vaginal tablets or 0,03 mg estriol pessaries with significant improvement of vaginal atrophy without risk of endometrial hyperplasia or even cancer development.

The currently valid German guideline on HRT states: A systemic hormone replacement therapy or a local estrogen treatment prevent vaginal atrophy or improve it. A low-dose local treatment has the same effect as a systemic application. A local estrogen treatment is superior to a placebo- or hormone-free regimen.

  • Statement: A hormone treatment is able to prevent or treat vaginal atrophy (LoE 1a).
  • Recommendation: If symptomatic local atrophy is the only indication for treatment, a local vaginal application of estrogens should be recommended (A)

CME Prakt Fortbild Gynakol Geburtsmed Gynakol Endokrinol 2014; 10(3): 192–204

Vaginal atrophy, HRT, local estrogens

Eckhard Petri
Universitäts-Frauenklinik Greifswald
Reviewer: Henrik Griesser, Köln,
und Petra Stute, Bern

Petri E. Vaginale ... Gynakol Geburtsmed Gynakol Endokrinol 2014; 10(3): 192–204 publiziert 30.11.2014 ©akademos Wissenschaftsverlag 2014 ISSN 1614-8533