Bothersome vulvovaginal symptoms are common in postmenopausal women, yet more than half are not receiving treatment. Nonhormonal treatments are preferred because of widespread concerns about the long-term safety of hormonal products, although the effects of low-dose hormonal treatment are not as well known. Researchers compared the efficacy of a low-dose vaginal estradiol tablet and a vaginal moisturizer with placebo for moderate-to-severe vulvovaginal symptoms in postmenopausal women.

Women ages 50 to 70 years who were at least two years postmenopausal and reported moderate-to-severe symptoms of vulvovaginal itching, pain, irritation, dryness, or pain on penetration were recruited for the study. A total of 302 women were randomized to receive a low-dose (10.3 mcg) vaginal estradiol tablet plus placebo gel, a placebo tablet plus vaginal moisturizer, or dual placebo. Women completed questionnaires on symptoms and symptom severity and underwent vaginal-sample collection at baseline and at 12 weeks. The primary outcome was the change in the severity of the most bothersome symptom between enrollment and weeks 4 and 12.

Neither vaginal estradiol nor vaginal moisturizer reduced symptom severity more than placebo. By 12 weeks, all groups had a mean decrease of 1.2 to 1.4 points from their baseline severity score (on a scale of 0 to 3, ranging from no symptoms to severe symptoms). Changes in Female Sexual Function Index scores were also similar in all groups, and all women expressed similar satisfaction with treatment.

The authors suggest that the choice of treatment for postmenopausal vulvovaginal symptoms should be based on individual patient preferences in terms of formulation and cost.

An editorial accompanying the article takes that conclusion a step further, suggesting that women should choose the least expensive over-the-counter moisturizer available unless new evidence emerges indicating that another treatment confers greater benefit.

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