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Hormonal Therapies

Hormonal pharmacotherapy for GSM, recurrent-UTI prevention, perioperative care, and gender-affirming treatment. The linked hubs distinguish approved indications and product-specific dosing from off-label use, surrogate tissue findings, and clinical outcomes. In IMPROVE (199 postmenopausal women randomized; 186 operated), perioperative vaginal conjugated-estrogen cream versus placebo did not improve 12-month composite success after native-tissue vaginal apical repair (no anatomic recurrence, bulge symptoms, or repeat prolapse treatment).[1] FDA menopausal-hormone labeling changes are product-specific; check the current label for the prescribed product.[2]

For testosterone replacement in male hypogonadism see Sexual Medicine & Andrology. For GSM and Gender-Affirming Surgery clinical articles see the linked pages.

  • Vaginal & Topical EstrogenLocal estrogen for genitourinary syndrome of menopause and recurrent UTI prevention, including use in cancer survivors.
  • Vaginal DHEA (Prasterone)Prasterone for menopausal VVA-related dyspareunia. Local metabolism includes estrogens and androgens. No established superiority over vaginal estrogen.
  • OspemifeneAn oral SERM for painful intercourse and vaginal dryness after menopause: dosing, interactions and warnings.
  • Vaginal Moisturizers & LubricantsNonhormonal relief for vaginal dryness and painful intercourse, and how to choose a product.
  • Preoperative Hormonal PrimingIMPROVE 12-month/3-year and EVA 2026 results: patient-reported benefit versus repair durability, uncertain postoperative-infection benefit, and the separate 2025 pessary trial.
  • Gender-Affirming Hormone TherapyEstrogen and testosterone regimens for gender-affirming care, with monitoring and perioperative management.

References​

1. Rahn DD, Richter HE, Sung VW, Pruszynski JE, Hynan LS. "Perioperative Vaginal Estrogen as Adjunct to Native Tissue Vaginal Apical Prolapse Repair: A Randomized Clinical Trial." JAMA. 2023;330(7):615–625. doi:10.1001/jama.2023.12317

2. US Food and Drug Administration. FDA Approves Labeling Changes to Menopausal Hormone Therapy Products. February 12, 2026. FDA release.