Variations on HRT.
Vaginal dryness like vasomotor symptoms should be easy to treat with estrogens. After the menopause women lose collagen from the skin, ligaments, bone matrix, the genital tract and bladder which can be corrected with hormone replacement.(29) These patients with symptoms of pelvic atrophy should have the same low dose oestradiol, with the appropriate progestogen if necessary, for as long as it takes to eradicate the symptoms. Local vaginal oestradiol or oestriol can be used. Progestogen is not normally added to this therapy although endometrial proliferation and hyperplasia may rarely occur. If bladder symptoms of urgency and recurrent “cystitis” are present a higher dose may be required for a longer duration regardless of whether the route of administration is local oral or transdermal.