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document
Low-dose , vaginally administered estrogens may enhance local benefits of systemic therapy in the treatment of urogenital atrophy in postmenopausal women on hormone therapy . BACKGROUND When genital atrophy exists , systemic hormone therapy ( HT ) has a timing until to induce vaginal proliferation and symptomatic relieve . Thus , in order to obtain a prompt improvement , the association of local therapy acting on the genital epithelium to the systemic treatment should be considered . OBJECTIVE To evaluate the effects of a combined therapy consisting of vaginal estriol with transdermal 17-beta-estradiol ( 50 microg/day ) plus medroxyprogesterone acetate ( 5 mg/day ) per os in shortening the period of uro-genital symptoms . SUBJECTS AND METHODS In a randomized , double blind , controlled with placebo study , 27 women with climacteric symptoms and atrophic vaginitis were treated for 4 months with HT plus vaginal estriol 0.5 mg/day ( group E ) or placebo ( group P ) . Patients use the local medication daily for the first 3 weeks and twice-weekly thereafter . Before entering in the study , patients were asked about HT and selected for inclusion . In the first visit , electible patients after written informed consent were randomized to receive HT plus local estriol or placebo . All the subjects had baseline studies , including medical history , physical examination , blood and urine analysis . In order to evaluate the effect of local treatment on urinary and genital symptoms , a score for genital , urinary and colposcopic complaints ( 0 minimum-100 maximum ) was developed . This score and Blatt-Kuperman were recorded and performed in every control . RESULTS There were no differences on climacteric symptoms relief between the two groups . Additionally , the improvement in urinary symptoms at the end of the study was similar for both groups ( from 16.5 +/- 6.1 to 8.5 +/- 2.4 for E group and from 15.8 +/- 7.8 to 8.8 +/- 2.7 for P group ; P < 0.01 versus basal ) ; however , those women in group E reached significant improvement on urinary complaints since the first month of treatment . Additionally , a significant difference between E and P was observed at months 2 and 3 , although no differences were detected at the end of the study . Papanicolaou smear showed reactive or reparative changes and karyopyknotic index exhibited a significant increase in superficial cells in both groups and at the end of the study . CONCLUSIONS Adding vaginal estriol to HRT may shorten the latency period for urinary symptoms .
20217
Intervention_Pharmacological
estrogens
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Intervention_Physical
systemic hormone therapy ( HT )
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Intervention_Control
placebo
20220
Intervention_Pharmacological
HT plus vaginal estriol 0.5 mg/day
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Intervention_Control
placebo
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Intervention_Pharmacological
HT plus local estriol
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Intervention_Control
placebo
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Outcome_Other
no differences on climacteric symptoms relief between the two groups
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Outcome_Other
improvement in urinary symptoms at the end of the study
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Outcome_Other
significant improvement on urinary complaints
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Outcome_Physical
superficial cells
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Participant_Condition
urogenital atrophy
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Participant_Condition
postmenopausal
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Participant_Sex
women
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Participant_Condition
on hormone therapy
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Participant_Sample-size
27
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Participant_Sex
women
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Participant_Condition
climacteric symptoms
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Participant_Condition
atrophic vaginitis