"The idea being that it's a very low targeted dose; it does not raise blood estrogen levels, but it can specifically treat a lot of genital and urinary symptoms that are associated with a low estrogen state," says Ashley G. Winter, MD.
In this video, Ashley G. Winter, MD, provides an overview of vaginal estrogen and uses for the treatment in women with genital and urinary symptoms. Winter is the chief medical officer of Odela Health in Los Angeles, California.
When we think of hormones that are used in cisgender women, most often people are talking about what is considered systemic hormone therapy, or menopause hormone therapy, which is estrogens used to raise the blood level of estrogen, usually a pill or a patch or some other delivery mechanism, along with potentially a synthetic progestin, micronized progesterone, and potentially even a low dose of testosterone. When we traditionally think of hormones that we're giving to women, those are the hormones we're typically thinking of. Now, what vaginal estrogen is is a form of estrogen that is specifically designed to be used locally within the vagina, potentially also on the vulvar vestibule and the vulva and periurethrally in women with the specific intent of supplying this tissue, which is very sensitive to estrogen, locally. The idea being that it's a very low targeted dose; it does not raise blood estrogen levels, but it can specifically treat a lot of genital and urinary symptoms that are associated with a low estrogen state. The technical term for the genital and urinary symptoms associated with low estrogen state is genitourinary syndrome of menopause, GSM.
However, we do know that if you are perimenopausal, you can have the same symptoms. So, there are people out there who are still menstruating who are having a decline in their estrogen levels, and they're manifesting symptoms in response to that declining estrogen. We also know that the suppression of hormones that can occur with certain types of hormonal contraceptives can cause these symptoms, along with other medications that modulate hormone levels. For example, some medications for hormonal acne. So, there is a potential wide range of use for it. I should say, these local hormone treatments don't have to just be vaginal estrogen. There are other FDA approved localized hormone regimens, not just vaginal estrogen. There's also an intravaginal DHEA–the brand name is Intrarosa–that is FDA approved for the same purpose, and there are vaginal estrogen suppositories, creams, a whole bunch of stuff. So that's the overall background.
This transcription has been edited for clarity.