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Safety of vaginal oestrogen in postmenopausal women

General Practitioner with a Special Interest in Menopause Care, The West London Menopause and PMS Centre, Queen Charlotte's and Chelsea Hospital, London, UK.

Nick Panay, MRCOG, Consultant Gynaecologist

The West London Menopause and PMS Centre, Queen Charlotte's and Chelsea Hospital, Du Cane Road, W12 0HS; and Chelsea and Westminster Hospital, Fulham Road, London, SW10 9NH, UK. email: nickpany{at}msn.com (corresponding author)

The vaginal delivery of oestrogen has a number of benefits including enhancement of the efficacy of treatment of urogenital symptoms and avoidance of the need for daily dosage of systemic hormone replacement therapy (HRT). Despite the undoubted benefits of vaginal unopposed oestrogenic preparations there have been concerns regarding safety, particularly with regards to endometrial hyperplasia. These concerns arose mainly from the use of high-dose synthetic oestrogen preparations used in the past for local relief of urogenital atrophy. The newer estriol and estradiol-containing vaginal hormone therapies are safe for short-term use. However, the majority of these preparations are only licensed for 3-6 months of continual use in the UK. Although observational data exist suggesting safety for long-term use, randomised prospective studies are required to confirm this. The purpose of this article is to review the spectrum of vaginal oestrogen-releasing preparations used in postmenopausal women.

Keywords Keywords / endometrium / hormone replacement therapy / menopause / progestogen / vaginal oestrogen