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Unlike vasomotor symptoms, the vaginal atrophy accompanying postmenopausal estrogen loss worsens rather than abates with time. Up to 40% of postmenopausal women experience vaginal dryness, vulvovaginal irritation and itching, or dyspareunia, although only about 25% of symptomatic women seek medical help. Localized estrogen delivered by vaginal cream, tablet, or ring is approved for use in North America and can alleviate symptoms without the adverse effects of systemic hormone therapy. The North American Menopause Society (NAMS) has published a position paper on the use of these modalities, based on available evidence. Highlights of the guidelines include the following:
Management goals are to relieve symptoms and reverse anatomic and physiol…