madman
Super Moderator
Objectives
Postmenopausal females often experience genitourinary symptoms like vulvovaginal dryness due to estrogen decline. Hormone replacement therapy is effective in alleviating vaginal atrophy and genitourinary syndrome in this population. Evaluate local estrogen’s safety and effectiveness for alleviating postmenopausal vaginal symptoms, including endometrial thickness, dyspareunia, vaginal pH, and dryness.
Methods
We searched Google Scholar, Cochrane Library, ClinicalTrial.Gov, PubMed, and ScienceDirect databases until July 2023. All randomized controlled trials (RCTs) linking intravaginal estrogen supplementation to vaginal atrophy or vaginitis were included. The risk of bias was evaluated with RoB 2, and publication bias was assessed using Egger and Beggs analysis.
Results
All evidence pertains to females. Eighteen studies (n = 4,723) compared estrogen with placebo. Patients using estrogen showed a significant increase in superficial cells (mean differences [MD]: 19.28; 95% confidence intervals [CI]: 13.40 to 25.16; I2 =90%; P < 0.00001) and a decrease in parabasal cells (MD: –24.85; 95% CI: –32.96 to –16.73; I2 = 92%; P < 0.00001). Vaginal pH and dyspareunia significantly reduced in estrogen users (MD: –0.94; 95% CI: –1.05 to –0.84; I2 = 96%) and (MD: –0.52; 95% CI: –0.63 to–0.41; I2 = 99%), respectively. Estrogen did not significantly affect vaginal dryness (MD: –0.04; 95% CI: –0.18 to 0.11; I2 = 88%). Adverse events like vulvovaginal pruritis, mycotic infection, and urinary tract infection were reported, but the association was insignificant (risk ratio: 0.95; 95% CI: 0.88 to 1.02; I2 = 0%).
Conclusions
Our meta-analysis of 18 RCTs suggests promising potential for intravaginal estrogen therapy in alleviating vaginal atrophy and vaginitis in postmenopausal females.
DISCUSSION
To the best of our knowledge, this is the largest study conducted to date including a total of 18 RCTs with 4,723 patients. The meta-analysis focused on estrogen based interventions administered intra-vaginally for a minimum period of three months in post-menopausal females to alleviate symptoms arising from vaginal atrophy or vaginitis. The included trials explored the contrast between the intervention (intravaginal estrogen supplementation) and a control group (placebo), using various forms such as creams, gels, tablets, triumphs,ovules, pessaries, and a ring that releases estrogen. Our meta-analysis revealed a reduction in maturation value, dyspareunia and vaginal pH. Upon dose-response analysis, females taking 15 μg of estrogen were shown to have a significant reduction in vaginal pH while those taking the < 2.5 μg and 50 μg had an insignificant effect on lowering vaginal pH. Upon subgroup analysis of follow-up duration, a significant association was observed in the 12-week follow-up for vaginal pH and dyspareunia. Lastly, the most common adverse events were vulvovaginal mycotic infection followed by vulvovaginal pruritis. These comprehensive findings contribute valuable insights into the multifaceted role of estrogen in managing vaginal health and associated symptoms within a scientific research context.
Conclusion
Our findings suggest that intravaginal estrogen the rapy, as evaluated in our comprehensive meta-analysis of 18 RCTs, holds significant promise for post-menopausal females with vaginal atrophy and vaginitis. The significant reduction in maturation value, characterized by an increase in superficial cells and a decrease in parabasal cells, suggests that estrogen contributes to improved vaginal health by fostering a more youthful and resilient vaginal epithelium. It effectively lowers vaginal pH, reduces dyspareunia, and improves maturation value. While its impact on vaginal dryness maybe less pronounced, the overall safety profile of estrogen therapy is favourable, with manageable adverse events. These insights empower healthcare providers to tailor treatment plans, offering effective relief and improving the quality of life for post-menopausal females dealing with these challenging symptoms.
Postmenopausal females often experience genitourinary symptoms like vulvovaginal dryness due to estrogen decline. Hormone replacement therapy is effective in alleviating vaginal atrophy and genitourinary syndrome in this population. Evaluate local estrogen’s safety and effectiveness for alleviating postmenopausal vaginal symptoms, including endometrial thickness, dyspareunia, vaginal pH, and dryness.
Methods
We searched Google Scholar, Cochrane Library, ClinicalTrial.Gov, PubMed, and ScienceDirect databases until July 2023. All randomized controlled trials (RCTs) linking intravaginal estrogen supplementation to vaginal atrophy or vaginitis were included. The risk of bias was evaluated with RoB 2, and publication bias was assessed using Egger and Beggs analysis.
Results
All evidence pertains to females. Eighteen studies (n = 4,723) compared estrogen with placebo. Patients using estrogen showed a significant increase in superficial cells (mean differences [MD]: 19.28; 95% confidence intervals [CI]: 13.40 to 25.16; I2 =90%; P < 0.00001) and a decrease in parabasal cells (MD: –24.85; 95% CI: –32.96 to –16.73; I2 = 92%; P < 0.00001). Vaginal pH and dyspareunia significantly reduced in estrogen users (MD: –0.94; 95% CI: –1.05 to –0.84; I2 = 96%) and (MD: –0.52; 95% CI: –0.63 to–0.41; I2 = 99%), respectively. Estrogen did not significantly affect vaginal dryness (MD: –0.04; 95% CI: –0.18 to 0.11; I2 = 88%). Adverse events like vulvovaginal pruritis, mycotic infection, and urinary tract infection were reported, but the association was insignificant (risk ratio: 0.95; 95% CI: 0.88 to 1.02; I2 = 0%).
Conclusions
Our meta-analysis of 18 RCTs suggests promising potential for intravaginal estrogen therapy in alleviating vaginal atrophy and vaginitis in postmenopausal females.
DISCUSSION
To the best of our knowledge, this is the largest study conducted to date including a total of 18 RCTs with 4,723 patients. The meta-analysis focused on estrogen based interventions administered intra-vaginally for a minimum period of three months in post-menopausal females to alleviate symptoms arising from vaginal atrophy or vaginitis. The included trials explored the contrast between the intervention (intravaginal estrogen supplementation) and a control group (placebo), using various forms such as creams, gels, tablets, triumphs,ovules, pessaries, and a ring that releases estrogen. Our meta-analysis revealed a reduction in maturation value, dyspareunia and vaginal pH. Upon dose-response analysis, females taking 15 μg of estrogen were shown to have a significant reduction in vaginal pH while those taking the < 2.5 μg and 50 μg had an insignificant effect on lowering vaginal pH. Upon subgroup analysis of follow-up duration, a significant association was observed in the 12-week follow-up for vaginal pH and dyspareunia. Lastly, the most common adverse events were vulvovaginal mycotic infection followed by vulvovaginal pruritis. These comprehensive findings contribute valuable insights into the multifaceted role of estrogen in managing vaginal health and associated symptoms within a scientific research context.
Conclusion
Our findings suggest that intravaginal estrogen the rapy, as evaluated in our comprehensive meta-analysis of 18 RCTs, holds significant promise for post-menopausal females with vaginal atrophy and vaginitis. The significant reduction in maturation value, characterized by an increase in superficial cells and a decrease in parabasal cells, suggests that estrogen contributes to improved vaginal health by fostering a more youthful and resilient vaginal epithelium. It effectively lowers vaginal pH, reduces dyspareunia, and improves maturation value. While its impact on vaginal dryness maybe less pronounced, the overall safety profile of estrogen therapy is favourable, with manageable adverse events. These insights empower healthcare providers to tailor treatment plans, offering effective relief and improving the quality of life for post-menopausal females dealing with these challenging symptoms.
