Rational prescribing for postmenopausal urogenital complaints.

Urogenital complaints such as vaginal discomfort, dysuria, dyspareunia, recurrent lower urinary tract infections (UTIs) and urinary incontinence have been reported to affect more than 50% of postmenopausal women. These symptoms cause considerable suffering and an obvious reduction in quality of life for the afflicted individual, as well as being costly in economic terms for the health service. Urinary incontinence alone has been estimated to account for approximately 2% of health care costs in both the US and Sweden. Treatment with low potency estrogens given locally or orally has been shown to alleviate urgency, urge incontinence, frequency, nocturia and dysuria, but there is no conclusive evidence that estrogens alone improve or cure stress incontinence. Estrogen therapy has also been shown to cure or alleviate local urogenital atrophy symptoms, and to induce positive changes in the vaginal bacterial flora of postmenopausal women, which in turn reduces the risk of developing a UTI. There is little or no documentation to support the use of antibiotics in the treatment of local urogenital complaints such as pruritus, vaginal discomfort and discharge, or urinary incontinence in postmenopausal women. Antibiotics are, however, indicated for the treatment of UTIs, and in some cases for prophylactic treatment in women with recurrent UTIs. The number of women with urogenital complaints is expected to increase in the future, as the proportion of elderly women will be greater due to a higher life expectancy. Thus, in the future there will be an even greater need for simple, effective forms of treatment for large numbers of elderly women. Low potency estrogens given topically or orally have been shown to be an effective form of treatment for urogenital symptoms in postmenopausal women.