Biehl C, et al. - Researchers analyzed published randomized controlled trials to determine the efficacy and safety of vaginal estrogen products in treating genitourinary syndrome of menopause (GSM). The inclusion criteria was met by 53 studies that evaluated the efficacy and safety of vaginal estrogen vs placebo or other hormone and nonhormone controls. Findings support the clinical efficacy of estrogen products for the treatment of GSM with doses as low as 4 μg. Although long-term controlled clinical trial safety data are lacking, vaginal estrogen products seem to be safe with few adverse effects. For the treatment of moderate-to-severe GSM, commercially available vaginal estrogen therapies seem to be an effective and safe first-line therapy.