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Local estrogen therapy (LET) is the standard treatment for urogenital symptoms. Various formulations and molecules have been used with similar results. Low-dose LET is preferred for minimal systemic absorption. Patient preference is crucial, but dissatisfaction exists. Breast cancer survivors and high-risk populations require special consideration. Studies focusing on quality of life, sexual function, and genitourinary conditions are needed for tailored treatment.

Take Home Points:

• Early use of LET, alone or combined with MHT, is crucial in managing urogenital aging in postmenopausal women with high GSM symptom severity.
• Tailored LET treatment should be based on the patient's profile, preferences, and treatment goals to prevent the negative impact of GSM on quality of life and sexual well-being.
• While there is a documented class effect of LET, different products may have specific benefits that need further exploration based on age, symptom type and severity, and clinical conditions.
• Poor compliance and treatment adherence among LET users can be attributed to efficacy and safety concerns.
• Studies focusing on the specific effects of LET on quality of life, sexual function, and genitourinary conditions are necessary, with a patient-tailored approach.