18 June 2021 Author : Leonor Santos Vaginal therapy with low doses of estrogen is one of the options to alleviate the symptoms of vaginal atrophy . This occurs naturally in menopause when the ovaries stop producing estrogens (hormones). Estrogens produced by the ovaries help to maintain vaginal moisture and tissues thickness and elasticity. What is vaginal atrophy? Vaginal atrophy is also known as vaginal dryness, atrophic vaginitis, vulvovaginal atrophy, or menopausal genitourinary syndrome. It is an alteration of the tissues of the vagina and vulva due to the interruption or decrease of estrogens production , which happens in several situations: In menopause; When the ovaries are removed surgically, for example in cancer; As a side effect of chemotherapy or radiotherapy treatments of the pelvic cavity; Transiently during breastfeeding; As a side effect during treatment with some medicines. Changes in local acidity that occur with the reduction or interruption of estrogen production by the ovaries make the tissues thinner, with less lubricating capacity and elasticity. Many women have troublesome symptoms associated with vaginal atrophy , such as: Discomfort and pain during sexual intercourse; Sensation of vaginal burning, itching or vaginal discharge. Vaginal atrophy can also affect the urethra and the bladder trigone and give rise to symptoms such as: Increased urinary frequency; Urinary urgency; Burning sensation when urinating. Women with vaginal atrophy may have an increased risk of urinary tract infections . Currently, several treatments for vaginal atrophy are available. What is low dose estrogen therapy? Vaginal estrogen therapy is the application of medicines containing estrogens locally , inside the vagina, where they exert their action. The quality of the vaginal mucosa is improved, making it thicker and more lubricated. There are several drugs for local application that contain low doses of estrogen, with different frequency of application and different pharmaceutical forms, for example creams, gels, pills or capsules, vaginal rings. These medications need a medical prescription and must be used according to medical advice, which may vary for each patient. Advantages of local therapy over systemic therapy When compared to systemic estrogen therapy, or hormone replacement therapy (usually in oral tablets or patches), local therapy has the advantage that its lower doses of estrogen are equally effective and there no effects on other organs, that systemic therapy can have. Women on hormone replacement therapy usually do not need vaginal therapy with estrogens, unless symptoms like vaginally dryness continue, an issue that should be discussed with the gynecologist. Safety of vaginal estrogen therapy Medicines with estrogens applied topically or vaginally have a reduced systemic absorption (absorption into the blood and then distribution throughout the body). For most women, its use is safe. The safety of vaginal estrogen therapy in women with breast cancer is not fully understood. Therefore, in these situations, the medical prescription of these treatments always considers the potential risks and benefits. What is the best option? The best treatment option depends on the specific circumstances of each woman problem, which should be discussed with the gynecologist . Different pharmaceutical forms have similar efficacy. Meet the obstetrics-gynecology team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
