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New study reveals that British women are 50% less likely to access local oestrogen treatment for common menopausal symptoms, compared to women in Europe and North America

17 June 2013


Crawley, UK, 17 June 2013: A new study published today in Menopause International highlights that the sex lives of British post-menopausal women with vaginal atrophy are more likely to suffer because of the condition1, yet they are 50% less likely to receive the recommended treatment, compared to their counterparts in Europe and North America1.

The first-of-its-kind study, called the CLarifying vaginal atrophy’s impact On SEx and Relationships (CLOSER) study, showed that British post-menopausal women with vaginal atrophy are more likely to experience less sex, and less satisfying sex, compared to other women in Europe and North America (67% and 61% vs 58% and 49% overall, respectively)1. Fear of painful sex was one of the main reasons women avoided intimacy (63%)1, with almost one third of women (30%) and male partners (29%) saying that vaginal discomfort had caused a “big problem” for their sex lives1

However, despite this elevated impact, British women are 50% less likely (21% versus 41% overall) to receive vaginal oestrogen preparations, compared to women from other countries1.

“Given the obvious impact of vaginal atrophy on women in the UK, and their partners, it is very sad to learn that we are lagging behind other Western countries in terms of ensuring appropriate access to treatment,” commented Dr Heather Currie, co-author of the study and Associate Specialist Gynaecologist at the Dumfries and Galloway Royal Infirmary, founder of and Honorary Secretary of the BMS. “It is our hope that the CLOSER study will encourage our fellow medical professionals to take the lead and initiate vaginal health conversations as a matter of routine for these women, thereby facilitating appropriate diagnosis and treatment.”

Decreased oestrogen levels in post-menopausal women prompt the development of urogenital changes and can result in vaginal atrophy, symptoms of which include vaginal dryness, soreness, itching and burning, as well as pain when touching the vagina or during intercourse5. Such pain may preclude women from desiring, initiating or responding to sexual activity and, if the condition is left untreated, they can develop serious long-term urogenital problems (e.g. incontinence)6.

Updated BMS recommendations on hormone replacement therapy (HRT) also published today
The publication of the CLOSER data is timely, as the updated recommendations on HRT by the BMS are including in the same edition of Menopause International.

With regards vaginal atrophy specifically, the updated recommendations reiterate that vaginal oestrogen preparations can be used long-term in symptomatic women as required, and that local oestrogen preparations have been shown to be effective in this context2. There is also no requirement to combine this with systemic progestogen treatment for endometrial protection, as low dose vaginal oestrogen preparations do not result in significant systemic absorption2.

“More than two-thirds (68%) of British women in CLOSER used lubricants and moisturisers to treat their vaginal symptoms1, but these are not as effective as oestrogen therapy as they do not treat the underlying cause2,” explained Dr Nick Panay, Consultant Gynaecologist, Queen Charlotte’s & Chelsea Hospital, London, Immediate Past Chair of the BMS and co-author of the recommendations and CLOSER study. “The updated BMS recommendations outline best practice for HRT prescribing, with the belief that all women can optimise their menopause with access to sufficient information from their doctor. I urge my colleagues to open an appropriate dialogue with patients to increase awareness of conditions like vaginal atrophy and the available treatments.”

In the CLOSER study, British women who had tried local oestrogen treatment for vaginal atrophy reported beneficial effects such as less painful sex (58%)7, more satisfying sex for their partner (42%)7 and themselves (40%)7, feeling closer and less isolated from their partner (33%)7, having sex more often (27%)7, and saying that they now look forward to having sex (26%)7.


  1. Domoney C, Currie H, Panay N, Maamari R, Nappi RE. The CLOSER survey: impact of postmenopausal vaginal discomfort on women and male partners in the UK. International Menopause Society [date and reference TBC]
  2. Panay N, Hamoda H, Arya R and Savvas M on behalf of The British Menopause Society. The 2013 British Menopause Society & Women's Health Concern recommendations on hormone replacement therapy. Menopause International. Published online before print May 2013;Accessble at:; doi: 10.1177/1754045313489645
  3. Nappi RE, Kokot-Kierepa M. Vaginal health: Insights, Views and Attitudes (VIVA) – results from an international survey. Climacteric. February 2012;15:36-44.
  4. Cardozo L, Bachmann G, McClish D, Fonda D, Birgerson L. Meta-analysis of estrogen therapy in the management of urogenital atrophy in postmenopausal women: second report of the Hormones and Urogenital Therapy Committee. Obstet Gynecol 1998;92:722–7. "
  5. Simon J, et al. Effective Treatment of Vaginal Atrophy With an ultra-Low-Dose Estradiol Vaginal Tablet. Obstetrics & Gynecology. 2008; 112(5):1053–1060.
  6. Hextall A. Oestrogens and lower urinary tract function. Maturitas. 2000;36:83–92.
  7. Domoney C, et al. Vaginal Health: When intimacy matters! British Menopause Society (BMS) Annual Congress, 2012.

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