Efectividad de los estrógenos vaginales

Para la AVV sintomática que no responde satisfactoriamente a intervenciones no hormonales, dosis bajas vaginales de TE parecen proveer mayor beneficio. Por décadas, estrógenos sistémicos y vaginales han sido el tratamiento recomendado para la AVV sintomática. El estrógeno aplicado a nivel local se ha convertido en el método preferido de uso cuando los síntomas vaginales son la única sintomatología. Baja dosis vaginal de TE puede proporcionar suficiente estrógeno para aliviar los síntomas con absorción sistémica mínima. Dentro de la vagina la TE ha demostrado ser más eficaz que la TE oral sistémica en el alivio de los síntomas de AVV con el 80% y el 90% de las mujeres que reportan una respuesta favorable, en comparación con el 75% de las mujeres que usan TE oral.64, 65

Los estudios sobre la eficacia de la TE vaginal han utilizado medidas de resultado subjetivas y objetivas, incluyendo: mejorías de los síntomas de atrofia (incluyendo dispareunia, cuando se buscó esta indicación), síntomas del tracto urinario inferior, apariencia de la mucosa vaginal, disminución en el pH vaginal, aumentos en el número de lactobacilos vaginales, cambios favorables en la citología o cambios en resultados de cultivo de orina vaginal y/o uretral, y la preferencia del paciente.

Se han reportado en la literatura muchos estudios que demuestran la eficacia de la TE vaginal7, 57,66-78. Organismos reguladores del gobierno confirman la eficacia de la TE vaginal para el tratamiento de la atrofia vaginal. Una revisión Cochrane de 2006, comparando 19 ensayos de eficacia, informó que todos los productos probados aliviarían los síntomas con eficacia similar.79 Esta conclusión se reafirmó en 2010. Pero los análisis comparativos de estos ensayos están limitados por las variaciones en los métodos y las medidas de resultado, los pequeños tamaños de las muestras y los resultados en la heterogeneidad sustancial. Algunos ensayos consideran una misma preparación, diferente de estrógeno, utilizando dosis o esquemas de dosificación. Algunos ensayos incluyeron preparaciones no aprobadas para su uso en los Estados Unidos o en Canadá. Varios ensayos no fueron ciegos. Sin embargo, no se han reportado nuevos trabajos de eficiencia desde entonces.

El beneficio terapéutico de la TE vaginal se ha observado en condiciones distintas de AVV, tales como en la reducción del riesgo de ITUs recurrentes80,81 y en la vejiga hiperactiva.82,83 El anillo de estradiol de dosis bajas ha sido aprobado para el tratamiento de disuria y urgencia urinaria. Sin embargo, la TH sistémica se ha asociado a un aumento de la incontinencia de estrés84-87y cálculos en el riñón.88

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Referencias

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