For a postmenopausal woman experiencing dyspareunia and vaginal pruritus, what would be the most appropriate treatment?

In the case of a postmenopausal woman dealing with symptoms such as dyspareunia (painful intercourse) and vaginal pruritus (itchiness), the most suitable treatment is often vaginal estrogen. This option directly addresses the localized effects of estrogen deficiency in the vaginal tissues that frequently occur after menopause.

Vaginal estrogen comes in various forms, including creams, rings, and tablets, which allow for targeted delivery of estrogen to the vaginal area. This localized treatment effectively helps to restore the natural moisture and elasticity of the vaginal tissues, alleviating pain during intercourse and reducing discomfort from itching.

While other treatments like oral estrogen, oral ospemifene, and vaginal dehydroepiandrosterone can also provide systemic or localized relief, they may not be the first line of treatment for localized vaginal symptoms in a postmenopausal woman. Vaginal estrogen is often preferred because it tends to have fewer systemic side effects than oral formulations, making it safer for women who may have contraindications to higher doses of systemic hormones. Therefore, vaginal estrogen is typically considered the most appropriate and effective treatment for this specific set of symptoms.