Overcoming resistance and barriers to the use of local estrogen therapy for the treatment of vaginal atrophy.

The purpose of this review is to summarize current information regarding the pathophysiology and management of vaginal atrophy (sometimes called "atrophic vaginitis") and to identify barriers to its treatment with local (or "topical") vaginal estrogen therapy. Relevant clinical trials, meta-analyses, and reviews were identified through the PubMed database. Local estrogen therapy is effective and safe for treatment of vaginal atrophy; however, barriers to treatment (eg, patient reluctance to discuss the condition, misinformation, incomplete understanding of the effectiveness and safety of available therapies) result in its underuse. Health care providers can help overcome barriers to effective treatment of vaginal atrophy by facilitating discussion with women about vaginal health. Discussions should occur at routine preventive health care examinations and during episodic visits when patients present with symptoms of vaginal atrophy. Education and counseling should include information on the importance of maintaining vaginal health and the benefits and risks of treatment, including the demonstrated effectiveness and safety profile of low-dose local estrogen therapy.