Vaginal Atrophy Research Paper
Running Head: TOPICAL ESTROGENS IN VAGINAL ATROPHY 1
Topical Estrogens in Vaginal Atrophy
TOPICAL ESTROGENS IN VAGINAL ATROPHY 2
Vaginal atrophy is a common result of the estrogen depletion after menopause. Most menopausal symptoms tend to get better as women get through the years of menopause but vaginal atrophy seems to get worse. Vaginal atrophy seems to affect 50% of menopausal women on average. (Kelley, 2007) Symptoms of vaginal atrophy are vaginal itching, burning, pressure and irritation. Estrogen also plays a big role in the musculature of the pelvic floor and the organs involved. The external and internal genitalia are predominately affected by the hormone estrogen. …show more content…
Major support ligaments are the pubococcygeus muscle and the musculature of the pelvic floor. Estrogen is present in most of these muscles and ligaments. The sacral nerves in the spinal cord influence the pudendal nerves of the pelvic floor. Estrogen receptors are present in all these areas. Estrogen can directly affect detrusor function through muscarinic receptors and calcium ion movement into cells. (Kelly, 2007)
Estrogen increases urethral resistance, raises the sensory threshold of the bladder, increases adrenoreceptor sensitivity in the urethral smooth muscle and promotes relaxation of the detrusor muscle. (Kelley, 2007)
The main symptoms of vaginal atrophy are vaginal dryness, loss of pelvic support with resulting prolapse, decrease in the tissue elasticity with resulting dyspareunia or pressure to void frequently and urogenital discomfort. The loss of estrogen in tissues can cause a reduced urinary flow rate, increased urinary residual volume, higher filling pressures, reduced bladder capacity and lower maximal voiding pressures. (Kelley, 2007) Urethral closure and pressure is a main component of continence. Vaginal symptoms are most common and more severe in smokers, due to increased estrogen metabolism and in women treated for breast cancer when compared to healthy postmenopausal women. (Ewies, 2009)
TOPICAL ESTROGENS IN VAGINAL ATROPHY 3
There have been many studies done on the use of topical vaginal estrogens for atrophic vaginitis.
Ericksen and Rasmussen (1992) studied the effect of vaginal estrogen in the tablet form (vagifem) in 164 women with subjective symptoms including burning, itching, dyspareunia and urological symptoms of frequency, dysuria and urgency. After 12 weeks of treatment, 62.8% of the treatment group experienced improvement in the symptoms compared to 32.4% in the placebo group. (Kelley, 2007)
There is concern about uterine endometrium proliferation with estrogen. A number of studies reviewed in the Cochrane Database have addressed this topic and the dose of topical estrogen is low enough in all vaginal creams, rings and tablets to not cause excessive proliferation of the uterine lining. (Kelley, 2007)
In the office we saw a 62 year old woman who was complaining of vaginal irritation and pressure. She has some stress incontinence with running. She was not sure if she had a UTI at the time but her urine was normal. Upon pelvic exam, she had a urethral caruncle and obvious vaginal atrophy. Ellen Goodwater, the NP that saw the patient has a lot of knowledge on this topic. She does bladder evaluations and pessarys in the office. She does a microscopic evaluation of the cells she scrapes from the vaginal wall and this patient has only basal cell’s left. These are the lowest cells in the wall which confirms that she has vaginal atrophy. She was placed on a topical estrogen cream …show more content…
to thicken and strengthen up the tissues and ligaments in the vagina and pelvic floor. She also did have a slight cystocele.
TOPICAL ESTROGENS IN VAGINAL ATROPHY 4
Ellen did a lot of teaching on the two types of kegels that she needs to do to help the pelvic floor muscles.
She also gave her some handouts to take home on all the topics discussed in the office. She is filling out a bladder diary and starting the Estrace vaginal cream. She will use is nightly Monday through Friday for a month and then come back in the office for a recheck. She will then go to use it 3x a week for maintenance.
In conclusion, I think that topical vaginal estrogens are a great solution to atrophic vaginitis, especially in women that cannot use oral estrogen because of their medical history. I think it important to bring this topic up to women in the office that we see because many women either just are embarrassed to talk about their problems in this area or just assume that it’s a normal part of again and there is nothing that can be done about it. That is why education is key and we can incorporate it in during the
exam.
TOPICAL ESTROGENS IN VAGINAL ATROPHY 5
References
Eriksen, P. & Rasmussen. H. (1992) Low dose 17B-estradiol vaginal tablets in the treatment of vaginal atrophy: a double blind placebo controlled study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 44, 137-144
Ewies, A. A. A. & Al-Baghdadi, O. (2009) Topical estrogen therapy in the management of postmenopausal vaginal atrophy: an up to date overview. Climacteric;12:91-105
Kelly, C. (2007) Estrogen and its effect on vaginal atrophy in post-menopausal women. Urologic Nursing. (1) 40-6
Topical Estrogens in Vaginal Atrophy
TOPICAL ESTROGENS IN VAGINAL ATROPHY 2
Vaginal atrophy is a common result of the estrogen depletion after menopause. Most menopausal symptoms tend to get better as women get through the years of menopause but vaginal atrophy seems to get worse. Vaginal atrophy seems to affect 50% of menopausal women on average. (Kelley, 2007) Symptoms of vaginal atrophy are vaginal itching, burning, pressure and irritation. Estrogen also plays a big role in the musculature of the pelvic floor and the organs involved. The external and internal genitalia are predominately affected by the hormone estrogen. …show more content…
Major support ligaments are the pubococcygeus muscle and the musculature of the pelvic floor. Estrogen is present in most of these muscles and ligaments. The sacral nerves in the spinal cord influence the pudendal nerves of the pelvic floor. Estrogen receptors are present in all these areas. Estrogen can directly affect detrusor function through muscarinic receptors and calcium ion movement into cells. (Kelly, 2007)
Estrogen increases urethral resistance, raises the sensory threshold of the bladder, increases adrenoreceptor sensitivity in the urethral smooth muscle and promotes relaxation of the detrusor muscle. (Kelley, 2007)
The main symptoms of vaginal atrophy are vaginal dryness, loss of pelvic support with resulting prolapse, decrease in the tissue elasticity with resulting dyspareunia or pressure to void frequently and urogenital discomfort. The loss of estrogen in tissues can cause a reduced urinary flow rate, increased urinary residual volume, higher filling pressures, reduced bladder capacity and lower maximal voiding pressures. (Kelley, 2007) Urethral closure and pressure is a main component of continence. Vaginal symptoms are most common and more severe in smokers, due to increased estrogen metabolism and in women treated for breast cancer when compared to healthy postmenopausal women. (Ewies, 2009)
TOPICAL ESTROGENS IN VAGINAL ATROPHY 3
There have been many studies done on the use of topical vaginal estrogens for atrophic vaginitis.
Ericksen and Rasmussen (1992) studied the effect of vaginal estrogen in the tablet form (vagifem) in 164 women with subjective symptoms including burning, itching, dyspareunia and urological symptoms of frequency, dysuria and urgency. After 12 weeks of treatment, 62.8% of the treatment group experienced improvement in the symptoms compared to 32.4% in the placebo group. (Kelley, 2007)
There is concern about uterine endometrium proliferation with estrogen. A number of studies reviewed in the Cochrane Database have addressed this topic and the dose of topical estrogen is low enough in all vaginal creams, rings and tablets to not cause excessive proliferation of the uterine lining. (Kelley, 2007)
In the office we saw a 62 year old woman who was complaining of vaginal irritation and pressure. She has some stress incontinence with running. She was not sure if she had a UTI at the time but her urine was normal. Upon pelvic exam, she had a urethral caruncle and obvious vaginal atrophy. Ellen Goodwater, the NP that saw the patient has a lot of knowledge on this topic. She does bladder evaluations and pessarys in the office. She does a microscopic evaluation of the cells she scrapes from the vaginal wall and this patient has only basal cell’s left. These are the lowest cells in the wall which confirms that she has vaginal atrophy. She was placed on a topical estrogen cream …show more content…
to thicken and strengthen up the tissues and ligaments in the vagina and pelvic floor. She also did have a slight cystocele.
TOPICAL ESTROGENS IN VAGINAL ATROPHY 4
Ellen did a lot of teaching on the two types of kegels that she needs to do to help the pelvic floor muscles.
She also gave her some handouts to take home on all the topics discussed in the office. She is filling out a bladder diary and starting the Estrace vaginal cream. She will use is nightly Monday through Friday for a month and then come back in the office for a recheck. She will then go to use it 3x a week for maintenance.
In conclusion, I think that topical vaginal estrogens are a great solution to atrophic vaginitis, especially in women that cannot use oral estrogen because of their medical history. I think it important to bring this topic up to women in the office that we see because many women either just are embarrassed to talk about their problems in this area or just assume that it’s a normal part of again and there is nothing that can be done about it. That is why education is key and we can incorporate it in during the
exam.
TOPICAL ESTROGENS IN VAGINAL ATROPHY 5
References
Eriksen, P. & Rasmussen. H. (1992) Low dose 17B-estradiol vaginal tablets in the treatment of vaginal atrophy: a double blind placebo controlled study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 44, 137-144
Ewies, A. A. A. & Al-Baghdadi, O. (2009) Topical estrogen therapy in the management of postmenopausal vaginal atrophy: an up to date overview. Climacteric;12:91-105
Kelly, C. (2007) Estrogen and its effect on vaginal atrophy in post-menopausal women. Urologic Nursing. (1) 40-6