The role of local vaginal estrogen treatment in urogenital atrophy

This is a review of currently available data on local vaginal estrogen treatment with critical comments and a view on future perspectives. Vaginal atrophy affects 25–50% of postmenopausal women, and 40–45% of sexually active women suffer from dyspareunia. Treatment with all available local estrogen preparations is effective, but studies on dose–response relationship are lacking as is noncompany-sponsored comparisons between different estrogens and formulations. Local estrogen is effective in the prevention of recurrent urinary tract infection, but data on incontinence are mixed. Epidemiological data, long-term clinical safety data and data in women with a history of breast and other cancers are lacking. Safety data beyond 1 year are needed to support actual use. The use of local therapy is still likely to increase.