Vaginal atrophy treatment: Initiation at any age is fine, study says

There is no best time to initiate low-dose vaginal oestrogen therapy (ET), since it improves the signs and symptoms of vaginal atrophy in both younger and older women, according to a posthoc analysis.

Data came from 198 postmenopausal women aged ≥45 years treated with 10-μg vaginal ET for 52 weeks. Outcomes were evaluated and compared between women aged <60 (n=143) and ≥60 years (n=55) at treatment initiation. Covariance analysis was applied.

Results for vaginal maturation index (for all cell layers; assessed by vaginal cytology samples), vaginal pH, and symptom scores were all encouraging in both age groups.

However, a significant between-group difference in cytological profiles (parabasal cells: estimated effect, –3.7; p=0.0003; intermediate cells: estimated effect, 5.8; p=0.0002) emerged. This was an indication that cellular responsiveness to treatment was less favourable among older women.

Specifically, the treatment effect on vaginal pH was less in the older age group, with a between-group difference of –0.19 (standard error, 0.05; p=0.0003).

While the findings suggest that treatment may be initiated at any age, the stronger response observed in younger women supports current clinical recommendations to start treatment early.

More importantly, treatment must be maintained to prevent recurrence of vaginal atrophy.