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Low-dose vaginal estrogen is an evidence-based option for genitourinary symptoms of menopause, including vaginal dryness, dyspareunia and some urinary symptoms. Compared with systemic estrogen therapy, local preparations produce much lower systemic exposure while directly treating the vaginal and lower urinary tract tissues affected by estrogen deficiency. For gynecologists, the treatment is particularly useful when symptoms are predominantly genitourinary rather than vasomotor. Counseling should address product selection, ongoing use and individual breast-cancer or thrombotic history. In women with a history of hormone-sensitive malignancy, treatment decisions should be coordinated with the relevant oncology team. The key clinical point is that genitourinary symptoms often require local therapy and may recur when treatment is stopped.
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Low-dose vaginal estrogen is an evidence-based option for genitourinary symptoms of menopause, including vaginal dryness, dyspareunia and some urinary symptoms. Compared with systemic estrogen therapy, local preparations produce much lower systemic exposure while directly treating the vaginal and lower urinary tract tissues affected by estrogen deficiency. For gynecologists, the treatment is particularly useful when symptoms are predominantly genitourinary rather than vasomotor. Counseling should address product selection, ongoing use and individual breast-cancer or thrombotic history. In women with a history of hormone-sensitive malignancy, treatment decisions should be coordinated with the relevant oncology team. The key clinical point is that genitourinary symptoms often require local therapy and may recur when treatment is stopped.
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