Vulvovaginal estrogen therapy for urinary symptoms in postmenopausal women: a review and meta-analysis.

Objective: This study aimed to summarize available evidence on the efficacy of vulvovaginal topical estrogen therapy on lower urinary tract symptoms (LUTS) of genitourinary syndrome of menopause.

Method: Multiple databases were systematically searched from inception to October 2024 to identify all studies providing pretreatment and post-treatment data for menopausal women with LUTS who received vulvovaginal estrogen therapy. A random effect meta-analysis was conducted (PROSPERO registration number: CRD42024517516).

Results: Seventeen studies were included for a total of 2111 patients. The pooled odds ratio for the occurrence of considered outcomes after versus before treatment was 0.14 (95% confidence interval [CI] 0.05-0.36; I² = 73%) for recurrent urinary tract infections, 0.12 (95% CI 0.05-0.29; I² = 62%) for stress urinary incontinence, 0.22 (95% CI 0.16-0.32; I² = 0%) for urge incontinence, 0.11 (95% CI 0.06-0.18; I² = 23%) for urgency, 0.22 (95% CI 0.16-0.23; I² = 0%) for frequency and 0.24 (95% CI 0.17-0.34; I² = 0%) for nocturia. The pooled mean difference for vaginal pH was -1.29 (95% CI -1.66 to -0.91; I² = 96%).

Conclusions: Vulvovaginal topical estrogen therapy appears to improve all analyzed LUTS in menopausal women. Available evidence supports current guidelines recommending vulvovaginal topical estrogen therapy for the management of these symptoms in menopausal women.