Treatment of urogenital atrophy in women not taking systemic estrogen

a. Moisturizers and lubricants. Regular use of a vaginal moisturizing agent (Replens) and lubricants during intercourse are helpful. Water soluble lubricants such as Astroglide are more effective than lubricants that become more viscous after application such as K-Y jelly. A more effective treatment is vaginal estrogen therapy. b. Low-dose vaginal estrogen

(1) Vaginal ring estradiol (Estring), a silastic ring impregnated with estradiol, is the preferred means of delivering estrogen to the vagina. The silastic ring delivers 6 to 9 pg of estradiol to the vagina daily for a period of three months. The rings are changed once every three months by the patient. Concomitant progestin therapy is not necessary.

(2) Conjugated estrogens (Premarin), 0.5 gm of cream, or one-eighth of an applicatorful daily into the vagina for three weeks, followed by twice weekly thereafter. Concomitant progestin therapy is not necessary.

(3) Estrace cream (estradiol) can also by given by vaginal applicator at a dose of one-eighth of an applicator or 0.5 g (which contains 50 pg of estradiol) daily into the vagina for three weeks, followed by twice weekly thereafter. Concomitant progestin therapy is not necessary.

(4) Estradiol (Vagifem). A tablet containing 25 micrograms of estradiol is available and is inserted into the vagina twice per week. Concomitant progestin therapy is not necessary.

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