The use of hormone therapy for the maintenance of urogynecological and sexual health post WHI

ABSTRACT

Background The loss of estrogen at menopause and the gradual decline in testosterone with age are associated with urogenital atrophy and, as a result, urogenital tract symptoms, including lower urinary tract symptoms and dyspareunia. These symptoms will persist unless treated.

Objective To review the prevalence of urogenital tract symptoms and sexual health problems associated with menopause and the role in the use of hormone therapy for the treatment of symptomatic women, with a specific focus on what has been learned since the first publication of the Women's Health Initiative (WHI) estrogen and estrogen + progestin studies.

Conclusion Studies support the use of local estrogen therapy, but not systemic estrogen therapy, for the treatment of urge urinary incontinence, overactive bladder and to reduce the number of urinary tract infections. The current evidence does not favor a beneficial effect on stress urinary incontinence. Local estrogen therapy is effective for the treatment of dyspareunia caused by vulvovaginal atrophy. Preliminary studies suggest a potential role for both intravaginal dehydroepiandrosterone and testosterone in the treatment of dyspareunia secondary to vulvovaginal atrophy, however, confirmatory studies are required before either therapy can be recommended. Post WHI, there is a need for medical practitioners to proactively raise the topic of urogynecological and sexual health in order to discuss the most suitable treatment option.

Key words::

• HORMONE THERAPY
• UROGYNECOLOGICAL HEALTH
• SEXUAL HEALTH
• WOMEN'S HEALTH INITIATIVE

Conflict of interest During the past 2 years, Professor Nappi had financial relationship (lecturer, member of advisory boards and/or consultant) with Bayer-Schering Pharma, Eli Lilly, Merck Sharpe & Dohme, Novo Nordisk, Pfizer Inc. Dr Davis is a consultant to Trimmel Pharmaceuticals, Warner Chilcott and BioSante Pharmaceuticals, Inc and has received research grant support from BioSante Pharmaceuticals, Inc. and Bayer-Schering Pharma.

Source of funding Nil.