Ultra-low-dose topical estrogen relieves vaginal atrophy

NEW YORK (Reuters Health) - An ultra-low dose of 10 micrograms of estradiol significantly improves vaginal tissue, pH balance, and urogenital symptoms in postmenopausal women with vaginal atrophy, new research suggests.

A 25-microgram estradiol tablet was first introduced as a treatment for vaginal atrophy in 1988, the researchers note in the medical journal Obstetrics & Gynecology. Initially, it was thought that 25 micrograms was required to effectively treat the condition, but recent reports have suggested that a 10-microgram dose also provides effective symptom relief.

To investigate further, Dr. James A. Simon, from the Women's Health and Research Consultants in Washington, DC, and colleagues assessed the outcomes of 309 postmenopausal women with vaginal atrophy who were randomly assigned to receive ultra-low-dose estradiol or a placebo for 52 weeks.

"Treatment instructions were to insert one vaginal tablet daily for 14 days, and subsequently one tablet twice per week," the team explains.

At week-12 follow-up, estradiol therapy was associated with significant improvements in the scores estimating vaginal health, vaginal pH and other measures compared with placebo treatment, the report indicates. Moreover, these benefits were first apparent after just 2 weeks of treatment.

Estradiol therapy was also significantly better than placebo at improving the most bothersome urogenital symptoms score. This treatment effect was first apparent at 4 weeks and became statistically significant at 8 weeks.

The improvements in vaginal tissue, pH balance and urogenital symptoms with ultra-low-dose estradiol were all maintained through 52 weeks, Simon and colleagues note.

No major adverse effects were noted with the ultra-low-dose estradiol.

These findings support the safety and efficacy of ultra-low-dose estradiol as a viable treatment option for vaginal atrophy, the researchers conclude.

SOURCE: Obstetrics & Gynecology, November 2008.