***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The women in this study were either post-menopausal or ovariectomised for at least 1 yr prior to the study . They had also been treated for cancer of the cervix ( 27 women ) , endometrium ( 5 ) , ovaries ( 5 ) or breast ( 1 ) . All women presented with sexual troubles , mainly genital discomfort ( dyspareunia or vaginism ) . In a double-blind fashion , gynaecological capsules containing either an oestradiol diether ( ICD : promestriene ) or only the excipient were administered for 40 consecutive days . At the end of the treatment , the FSH , LH , oestrone ( E1 ) and oestradiol ( E2 ) plasma levels were not found to be significantly different from the pre-therapeutic values . These results suggest that promestriene acts on the vaginal mucosa , therefore not being converted back into the hormone from which it was derived . Also , in its dietheroxide form , promestriene is incapable of crossing the malpighian ( vaginal or epidermal ) epithelium and of reaching the general blood circulation . This discrepancy between the local anti-atrophic effects and the inability to exert systemic oestrogen activities singles out promestriene and justifies its therapeutic use when hormonally active oestrogens are contra-indicated , as in patients who have an oestrogen-sensitive cancer in their medical history Silicone vaginal rings for the continuous release of 17 beta-oestradiol ( E2 ) with 2 constant in vitro release rates were used for the treatment of symptoms of urogenital atrophy in 2 groups of postmenopausal women . The very low dose of 7 micrograms/24 h was found to alleviate atrophic symptoms effectively and to induce significant maturation of vaginal and urethral epithelium . After a brief initial peak , the serum levels of E2 over 3 mth of treatment remained close to the detection limit . The ' undetectable ' E2 release pattern was reflected only in increased levels of oestrone sulphate . There was no evidence of a systemic metabolic response and patient acceptance of the method was excellent . Continuous low-dose release of E2 via vaginal rings consequently offers an alternative means of administering local oestrogen therapy which may be particularly suitable for geriatric patients OBJECTIVE : To evaluate the efficacy of two vaginal doses of estradiol ( E2 ) compared with placebo in the treatment of atrophic vaginitis . METHODS : In a multi-center , r and omized , double-blind , parallel-group study , 230 postmenopausal women received treatment with 25 mcg or 10 mcg E2 or placebo for 12 weeks . Efficacy was measured through composite score of three vaginal symptoms and grading of vaginal health . Additional analyses included maturation of vaginal and urethral mucosa . Safety assessment s included endometrial biopsy , adverse events , changes in laboratory tests , and physical examinations . After 12 weeks of treatment , all patients were switched to the open-label extension and received treatment with 25 mcg E2 up to week 52 . RESULTS : Vaginal tablets with 25 mcg and 10 mcg E2 showed significant ( P<.001 ) improvement in composite score of vaginal health . Other results with 10 mcg E2 were not entirely consistent with those for 25 mcg E2 . Over 12 weeks , both active treatments result ed in greater decreases in vaginal pH than placebo . There were no significant differences between the 25 mcg and 10 mcg E2 groups in terms of improvements in maturation value or composite score of three vaginal symptoms . The efficacy was maintained to week 52 with 25 mcg E2 . CONCLUSION : Vaginal tablets with 25 mcg and 10 mcg E2 provided relief of vaginal symptoms , improved urogenital atrophy , decreased vaginal pH , and increased maturation of the vaginal and urethral epithelium . Those improvements were greater with 25 mcg than with 10 mcg E2 . Both doses were effective in the treatment of atrophic vaginitis . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00465192 and NCT00464971 LEVEL OF EVIDENCE : Objective : The aim of this study was to evaluate the efficacy and safety of low-dose conjugated estrogens ( CE ) cream for treatment of atrophic vaginitis . Methods : Postmenopausal women ( N = 423 ) with moderate-to-severe vaginal atrophy were r and omized to CE cream 0.3 mg or placebo once daily ( 21 days on/7 days off ) or twice weekly for 12 weeks , followed by open-label treatment with CE cream for 40 weeks consistent with their prior regimen . Primary endpoints were changes in vaginal maturation index ( VMI ; percentage of superficial cells ) , vaginal pH , and severity of participant-reported most bothersome symptom ( vaginal dryness , itching , burning , or dyspareunia ) at week 12 . Endometrial safety was assessed by transvaginal ultrasound and endometrial biopsy for 52 weeks . Results : At week 12 , improvements in VMI with daily and twice-weekly use of low-dose CE cream ( 27.9 % and 25.8 % , respectively ) were significantly greater compared with placebo ( 3.0 % and 1.0 % , respectively ; P < 0.001 ) . Improvements in vaginal pH with daily and twice-weekly CE cream ( −1.6 for both ) were also significantly greater relative to placebo ( −0.4 and −0.3 , respectively ; P < 0.001 ) . VMI and vaginal pH responses were sustained through 52 weeks . Both CE cream regimens significantly reduced most bothersome symptom scores compared with placebo ( P ≤ 0.001 ) , including those for dyspareunia ( P ≤ 0.01 ) . There was no report of endometrial hyperplasia or carcinoma . Adverse events occurred with similar frequency among the active and placebo groups during the double-blind phase . Conclusions : Daily and twice-weekly use of low-dose CE cream was equally effective in relieving symptoms of vulvovaginal atrophy  . Both regimens showed endometrial safety and sustained efficacy during 1 year of therapy Objective To assess the efficacy and safety of intravaginal estriol administration on  urinary incontinence , urogenital atrophy , and recurrent urinary tract infections in postmenopausal women . Design Eighty-eight postmenopausal women with urogenital aging symptoms were enrolled in this prospect i ve , r and omized , placebo-controlled study . Participants were r and omly divided into two groups , with each group consisting of 44 women . Women in the treatment group received intravaginal estriol ovules : 1 ovule ( 1 mg ) once daily for 2 weeks and then 2 ovules once weekly for a total of 6 months as maintenance therapy . Women in the control group received inert placebo vaginal suppositories in a similar regimen . We evaluated urogenital symptomatology , urine cultures , colposcopic findings , urethral cytologic findings , urethral pressure profiles , and urethrocystometry before as well as after 6 months of treatment . Results After therapy , the symptoms and signs of urogenital atrophy significantly improved in the treatment group in comparison with the control group . Thirty ( 68 % ) of the treated participants , and only seven ( 16 % ) of the control participants registered a subjective improvement of their incontinence . In the treated participants , we observed significant improvements of colposcopic findings , and there were statistically significant increases in mean maximum urethral pressure , in mean urethral closure pressure as well as in the abdominal pressure transmission ratio to the proximal urethra . Urethrocystometry showed positive but not statistically significant modifications . Conclusions Our results show that intravaginal administration of estriol may represent a satisfactory therapeutic choice for those postmenopausal women with urogenital tract disturbances who have contraindications or refuse to undergo st and ard hormone therapy tis trial , placebo controls can be used because the riskbenet ratio of no therapy is only slightly less favorable than the risk-benet ratio of any available therapy , and the result ing knowledge may contribute to the welfare of those who suffer from allergies . On this alternative view , therapeutic benecence is maintained as the moral st and ard for determining whether participation in placebo-controlled trials may be offered to subjects . It can not be dispensed with in any event , because it provides the st and ard against which placebo use must be assessed to determine that the increment of risk to subjects is not excessive . Once this determination is made , subjects may be invited to consider whether r and omization is a matter of “ approximate indifference ” in the light of their own values and goals ( Veatch 2002 ) . However , given the vagaries of assuring adequately informed consent in the real world of clinical research , therapeutic benecence should be maintained as an independent , threshold st and ard for determining whether placebo-controlled trials can be undertaken with proper regard for the welfare of subjects . On the other h and , therapeutic benecence does not constitute an absolute priority . When placebo-controlled trials impose only a modest increment of risk compared to best available therapy , then subjects may be invited to participate if doing so is necessary to contribute to the welfare of patients as a group . Miller and Brody are right about this conclusion but wrong about the underlying rationale . Background : Vaginal atrophy is a common complication in menopause which does not improve with time and , if untreated , can affect the quality of life for women . The aim of this study was to compare the effectiveness of the vaginal cream of hyaluronic acid and conjugated estrogen ( Premarin ) in treatment of vaginal atrophy . Methods : This study was a r and omized controlled clinical trial on 56 menopausal women with symptoms of vaginal atrophy ; they were r and omly allocated to two groups ( recipient conjugated estrogen and hyaluronic acid ) . The severity of each sign of atrophy was evaluated by visual analog signals ( VAS ) and on the basis of a four point scale . Also to recognize the cellular maturation with pap smear and the maturation degree were calculated according to the formula and scores 0 - 100 . As to the vaginal PH , we used PH marker b and , the rate of which was divided into 4 degrees . Data were analyzed using SPSS , version 20 , and P≤0.05 was considered as significant . Results : The results of this study showed that the symptoms of vaginal atrophy compared with the baseline level were relieved significantly in both groups . Dryness , itching , maturation index , PH and composite score of the vaginal symptoms were relieved significantly in both groups ( P<0.001 ) . Dyspareunia in Premarin ( P<0.05 ) and hyaluronic acid ( P<0.001 ) decreased compared with pre-treatment . Urinary incontinence only showed improvement in the hyaluronic acid group ( P<0.05 ) . Improvement in urinary incontinence , dryness , maturation index ( P<0.05 ) and composite score of vaginal symptoms ( P<0.001 ) in the hyaluronic acid group was better than those in the Premarin group . Conclusion : According to the results of the present study , hyaluronic acid and conjugated estrogen improved the symptoms of vaginal atrophy . But hyaluronic acid was more effective and this drug is suggested for those who do not want to or can not take local hormone treatment . Trial Registration Number : I RCT Fifty-one post-menopausal women suffering from symptoms of oestrogen deficiency-derived atrophic vaginitis were treated intravaginally with two therapeutic regimens based on doses of 25 micrograms 17 beta-oestradiol ( E2 ) in an open , controlled study . All the patients received treatment daily for 2 weeks by way of induction therapy . They were then r and omly allocated to either once-weekly ( 17 patients ) or twice-weekly ( 34 patients ) vaginal administration for a further 50 weeks as maintenance treatment . Endometrial histopathology was evaluated before and after 1 year of treatment . The effects on symptoms and oestrogen/gonadotrophin levels were determined before and after 2 , 12 , 24 , 36 and 52 weeks of therapy . Nine women continued twice-weekly treatment for a further year , meaning that they underwent treatment for a total period of 2 years . Endometrial biopsies were obtained after 2 years of treatment . All the pretreatment endometrial biopsies indicated an atrophic endometrium . One patient out of the 14 who completed 1 year of therapy in the group treated once weekly showed weak proliferation of the endometrium , while the other 13 had an atrophic endometrium . In the group treated twice weekly , 2 out of the 31 patients who completed the study showed weak proliferation of the endometrium . The other 29 had an atrophic endometrium . All 9 women who received treatment for 2 years had an atrophic endometrium at the end of the treatment period . The twice-weekly dosage regimen gave complete relief of symptoms in almost all patients , whereas the majority of the patients in the group treated once weekly still had mild symptoms . No adverse effects were reported . ( ABSTRACT TRUNCATED AT 250 WOR 
    Output:
    
AUTHORS ' CONCLUSIONS There was no evidence of a difference in efficacy between the various intravaginal oestrogenic preparations when compared with each other .
However , there was low- quality evidence that intra-vaginal oestrogenic preparations improve the symptoms of vaginal atrophy in postmenopausal women when compared to placebo .
There was low- quality evidence that oestrogen cream may be associated with an increase in endometrial thickness compared to oestrogen ring ; this may have been due to the higher doses of cream used .
However there was no evidence of a difference in the overall body of evidence in adverse events between the various oestrogenic preparations compared with each other or with placebo