Estradiol cream plus silicone lubricant may diminish dyspareunia

Key takeaways :

• Median intercourse pain scores with use of estradiol cream groups lowered by 50% after 4 weeks and by 75% after 12 weeks.
• Pain at the vulvar vestibule improved from 82% to 100% with estradiol cream therapy.

Estradiol cream applied to the vulvar vestibule plus precoital silicone lubricant may offer an alternative to vaginal therapy for women with dyspareunia, according to a randomized pilot trial published in Menopause.

“Genitourinary syndrome of menopause is known to progress with time after menopause and to reduce quality of life for both women and their partners,” Martha F. Goetsch, MD, MPH, of the department of obstetrics and gynecology at Oregon Health and Science University, Portland, and colleagues wrote. “Intravaginal application of estradiol therapy is the standard for treating genitourinary syndrome of menopause. In addition to the often-expressed concerns about estrogen exposure, many women find it to be inadequate for relief.”

This randomized, double-blind, comparative pilot trial included 50 postmenopausal women (mean age, 59.7 years) who reported pain with intercourse between June 2017 and August 2019. Participants were randomly assigned to use 50 µg (n = 25) or 100 µg (n = 25) nightly applications of estradiol cream for 12 weeks. Participants were asked to have lubricated penetration twice weekly with intercourse or via a tampon test. Participants recorded their pain in diaries and rated it on a 0 to 10 numerical rating scale. Researchers also evaluated biopsychosocial outcomes and urinary symptoms, measured serum estradiol levels and endometrial stripe thicknesses, and performed physical examinations to assess tenderness levels of the vestibule, vagina, pelvic floor muscles, bladder, uterus and adnexa.

Overall, 94% of participants completed 4 weeks of protocol and 92% completed 12 weeks. At 4 weeks, 91% of participants missed fewer than five estradiol doses. The median intercourse pain score at baseline was 8.

After 12 weeks, researchers observed no statistically significant difference between the estradiol cream groups in change in intercourse pain score, tampon test score, assessment of quality of life and urinary symptoms or physical examination measures. When combined, the median intercourse pain score for both groups lowered by 50% at 4 weeks and by 75% at 12 weeks (P < .001).

In addition, vulvar vestibular pain improved from 82% to 100% (P < .001) with estradiol cream therapy. There was no statistically significant difference in serum estradiol level or endometrial stripe thickness between groups.

“Use of outcome measures from vulvar pain research provides a more expansive description of dyspareunia associated with genitourinary syndrome of menopause and may help to refine our therapies,” the researchers wrote.