MEDICAL AND SURGICAL STRATEGIES FOR TREATING UROGYNECOLOGICAL DISORDERS

Symptoms and signs of the urogenital estrogen deficiency syndrome occu r relatively late in a woman's life when endogenous estrogen levels ar e well below those required to stimulate endometrial growth. At age 60 and above symptoms are common and progress with advancing age. The fi rst and most common complaint is vaginal dryness, but symptoms of lost control of micturition as well as urge incontinence are also frequent . Recurrent infections of the lower urinary tract are common, as well as dyspareunia and a sensation of burning and itching. One third of wo men about age 60 suffer from urogenital estrogen deficiency syndromes, a figure that rises to two thirds at the age of 75. With a rapid grow th of the elderly female population, these symptoms are an increasing burden to the individual as well as to any given health care system. S everal clinical trials have repeatedly demonstrated the efficacy in al leviating these symptoms of low daily estrogen doses as exemplified by 8 mu g/day of vaginally administered estradiol. For reasons not compl etely understood, the urogenital tissues respond to this low estrogen level but the endometrium does not. Hence, estrogen therapy aiming at mitigating urogenital deficiency symptoms could be given without a pro gestogen. No side effects have been described for vaginal preparations , and neither absolute nor relative contraindications exist. No protec tion is offered against cardiovascular disease or osteoporosis, though . In 1991, vaginal low-dose estrogens were declared OTC preparations i n Sweden. The costs for the society for this program can be Limited to the costs of medication only, for medical monitoring is not compulsor y. The clinical efficacy is remarkable, and urogenital symptoms are al most abolished in elderly women receiving this type of treatment, whic h is practically devoid of side effect.