Anatomical and Dermatologic Manifestations of Estrogen Deficiency in Postmenopausal Women: A Systematic Review
Dermatologic Manifestations of Estrogen Deficiency in Postmenopausal Women
DOI:
https://doi.org/10.54393/pjhs.v6i12.3614Keywords:
Estrogen Deficiency, Postmenopause, Vaginal Atrophy, Dermatologic Changes, Vaginal Estradiol , Ultrasound Imaging, Fractional CO₂ Laser, Genitourinary Syndrome of Menopause, Vulvovaginal AtrophyAbstract
Estrogen deficiency after menopause contributes to structural and symptomatic changes in genital, cutaneous, and adnexal tissues, yet available evidence remains scattered across clinical and imaging disciplines. Objectives: To summarize contemporary evidence on anatomical and dermatologic manifestations of estrogen deficiency in postmenopausal women and to evaluate the effects of local hormonal and device-based treatments. Methods: A systematic review following PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar were searched for English-language studies from 1 January 2017 to 31 December 2024. Eligible designs included randomized controlled trials, observational and cross-sectional studies, imaging investigations, and pilot interventions involving naturally or surgically postmenopausal women. Outcomes included clinical signs, symptom scores, imaging parameters, and dermatologic manifestations. Risk of bias was assessed using the Cochrane RoB-2 tool for randomized trials and the Newcastle–Ottawa Scale for observational and imaging studies. Results: Eighteen studies met the inclusion criteria. Randomized trials of low-dose vaginal estradiol and selective estrogen receptor modulators improved vaginal pH, Vaginal Health Index, Vaginal Maturation Index, dryness, and dyspareunia with minimal systemic absorption. Dermatology-focused cohorts commonly reported xerosis, pruritus, dermatoses, nail fragility, and female-pattern hair loss. Imaging studies demonstrated reduced dermal and vaginal wall thickness and altered echogenicity. Evidence for fractional CO₂ laser and radiofrequency remained limited to small pilot studies with short follow-up. Conclusions: Estrogen deficiency is consistently associated with measurable structural and symptomatic changes in genital and cutaneous tissues. Local estrogen therapy offers reliable short-term benefits, whereas device-based interventions remain investigational and require larger controlled trials.
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