Estrogen replacement therapy for the treatment of postmenopausal genitourinary tract dysfunction.

Considerable debate exists over the use of estrogen replacement therapy in post-menopausal women. Valuable level 1 evidence has been obtained through randomized controlled clinical trials; even so, little consensus exists on its use. Several genitourinary complaints correlate temporally with estrogen depletion at the time of menopause; likewise, estrogen replacement has been felt to improve many of these conditions. We will review the indications and evidence for estrogen therapy in the treatment of genitourinary symptoms as well as the hallmark clinical trials that address urinary incontinence, overactive bladder symptoms, urinary tract infections, vaginal atrophy and dyspareunia.