Shawna L. Johnston, MD, FRCSC, Assistant Professor, Department of Obstetrics and Gynecology, Queen's University, Kingston, ON.
The population of postmenopausal women in Canada is growing rapidly. It is now estimated that there are more than four million women in Canada over the age of 50. Menopause, hormone replacement and the sequelae of estrogen deprivation will become important foci for health care in this century.
Urogenital aging occurs as a result of estrogen deprivation in menopause and of tissue aging itself. Problems originate from the lower urinary tract (urethra and bladder) and from the vagina. Vaginal complaints include dryness, dyspareunia, discharge and/or bleeding. Estimates of prevalence suggest that 40-50% of postmenopausal women are affected. These symptoms, while not life-threatening, can be extremely uncomfortable and limiting, and can negatively impact on quality of life.
Estrogen replacement therapy has long been the mainstay of treatment for vaginal atrophy. Both oral and vaginal estrogen are effective, though the vaginal route is often chosen because it avoids the enterohepatic circulation and can therefore be given in much lower doses. Estrogen can be administered vaginally as a cream. Newer methods of delivery include estradiol vaginal tablets and sustained release intravaginal estradiol rings. Effective nonhormonal alternatives include the vaginal moisturizer, polycarbophil.