Question: How to treat atrophic vaginitis in a 48 yr old lady who had TAH BSO for endometrial carcinoma stage 1 six months back.
Answer: A Cochrane review of local oestrogen for vaginal atrophy in postmenopausal women (1) found that “creams, pessaries, tablets and the oestradiol vaginal ring appeared to be equally effective for the symptoms of vaginal atrophy. One trial found significant side effects following cream (conjugated equine oestrogen) administration when compared to tablets causing uterine bleeding, breast pain and perineal pain. Another trial found significant endometrial overstimulation following use of the cream (conjugated equine oestrogen) when compared to the ring. As a treatment choice women appeared to favour the oestradiol-releasing vaginal ring for ease of use, comfort of product and overall satisfaction.” (Evidence level 1a)
A randomized controlled trial including 53 postmenopausal women (2) reported that, compared to placebo, red clover supplementation led to “a significant improvement of the karyopyknotic, cornification and basal cell maturation index. This was correlated with a decrease in the rate of women having dyspareunia, vaginal dryness and decreased libido”. (Evidence level 1b)
References:
- Suckling JA, Kennedy R, Lethaby A, Roberts H. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD001500. DOI: 10.1002/14651858.CD001500.pub2. Abstract (and full text in some countries). Full text for Fellows, Members and Trainees
- Chedraui P, Hidalgo L, San Miguel G, Morocho N, Ross S Red clover extract (MF11RCE) supplementation and postmenopausal vaginal and sexual health. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2006 95(3): 296-7
Search date: May 2009
Classification of evidence levels
Ia Evidence obtained from meta-analysis of randomised controlled trials.
Ib Evidence obtained from at least one randomised controlled trial.
IIa Evidence obtained from at least one well-designed controlled study without randomisation.
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.
III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.
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