1 Maturation value Show forest plot

2

341

Mean Difference (IV, Fixed, 95% CI)

0.79 [‐1.52, 3.09]

2 Vaginal pH (decrease) Show forest plot

1

165

Mean Difference (IV, Fixed, 95% CI)

0.10 [‐0.19, 0.39]

3 Physical appearance of vagina (physician assessment of improvement) Show forest plot

3

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Atrophy (improvement)

2

341

Odds Ratio (M‐H, Fixed, 95% CI)

1.02 [0.65, 1.58]

3.2 Pallor (improvement)

2

341

Odds Ratio (M‐H, Fixed, 95% CI)

1.44 [0.88, 2.36]

3.3 Petechiae (improvement)

2

341

Odds Ratio (M‐H, Fixed, 95% CI)

1.03 [0.62, 1.71]

3.4 Friability (improvement)

2

341

Odds Ratio (M‐H, Fixed, 95% CI)

0.93 [0.54, 1.58]

3.5 Dryness (improvement)

2

341

Odds Ratio (M‐H, Fixed, 95% CI)

1.44 [0.87, 2.39]

3.6 pH improvement/normal

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

0.83 [0.43, 1.63]

4 Improvement in symptoms or cure (patient assessment) Show forest plot

2

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 Dryness (improvement)

2

341

Odds Ratio (M‐H, Fixed, 95% CI)

1.29 [0.75, 2.22]

4.2 Pruritis (Improvement)

2

341

Odds Ratio (M‐H, Fixed, 95% CI)

2.71 [1.66, 4.43]

4.3 Dyspareunia (improvement)

2

341

Odds Ratio (M‐H, Fixed, 95% CI)

0.69 [0.41, 1.14]

5 Proportion of responders (parabasal cells decreased >25%) Show forest plot

2

357

Odds Ratio (M‐H, Fixed, 95% CI)

0.95 [0.58, 1.58]

6 Adherence to treatment/participation levels Show forest plot

2

350

Odds Ratio (M‐H, Fixed, 95% CI)

2.23 [1.31, 3.80]

7 Withdrawal because of adverse events Show forest plot

2

386

Odds Ratio (M‐H, Fixed, 95% CI)

1.52 [0.56, 4.11]

8 Proportion with separate adverse events Show forest plot

2

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 Abdominal pain

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

1.59 [0.06, 39.56]

8.2 Arthralgia/myalgia

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

1.59 [0.06, 39.56]

8.3 Breast pain/enlargement/engorgement

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

0.12 [0.01, 1.13]

8.4 Bullous eruption

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

1.59 [0.06, 39.56]

8.5 Cervical ulceration/inflammation

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

0.52 [0.03, 8.45]

8.6 Depression

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

0.17 [0.01, 4.30]

8.7 Dysuria

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

8.8 Oedema generalised

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

0.10 [0.00, 2.16]

8.9 Flatulence

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

0.17 [0.01, 4.30]

8.10 Genital eruption

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

1.59 [0.06, 39.56]

8.11 Headache

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

1.05 [0.09, 11.78]

8.12 Heart disorder

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

1.59 [0.06, 39.56]

8.13 Hypothesia

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

1.59 [0.06, 39.56]

8.14 Increased appetite

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

8.15 Leukorrhea

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

1.59 [0.06, 39.56]

8.16 Moniliasis

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

0.78 [0.13, 4.79]

8.17 Pruritis

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

0.17 [0.01, 4.30]

8.18 Skeletal pain

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

8.19 Sweating/hot flushes

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

0.05 [0.00, 1.04]

8.20 Urinary incontinence

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

1.59 [0.06, 39.56]

8.21 Urinary tract infection

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

0.17 [0.01, 4.30]

8.22 Vaginal bacterial growth asymptomatic

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

0.49 [0.18, 1.38]

8.23 Vaginal fungal growth asymptomatic

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

0.26 [0.02, 2.88]

8.24 Vaginal haemorrhage

2

386

Odds Ratio (M‐H, Fixed, 95% CI)

0.71 [0.25, 2.08]

8.25 Vaginal pain

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

2.67 [0.13, 56.44]

8.26 Vaginitis

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

8.35 [0.47, 148.46]

8.27 Vulvar irritation/vulvitis

2

386

Odds Ratio (M‐H, Fixed, 95% CI)

1.64 [0.48, 5.60]

8.28 total adverse events

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

0.88 [0.47, 1.63]

9 Acceptability of treatment Show forest plot

3

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 Comfort of product

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

8.69 [4.20, 17.95]

9.2 Ease of use

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

11.22 [5.51, 22.84]

9.3 Overall product rating

1

192

Odds Ratio (M‐H, Fixed, 95% CI)

5.45 [2.66, 11.16]

9.4 delivery system rating(excellent/good)

2

341

Odds Ratio (M‐H, Fixed, 95% CI)

6.08 [3.70, 10.00]

10 Endometrial thickness > 5mm Show forest plot

1

95

Odds Ratio (M‐H, Fixed, 95% CI)

0.45 [0.11, 1.80]

11 Hyperplasia Show forest plot

1

69

Odds Ratio (M‐H, Fixed, 95% CI)

2.24 [0.09, 56.98]

12 Incidence of bleeding(progestagen challenge test) Show forest plot

2

274

Odds Ratio (M‐H, Fixed, 95% CI)

0.29 [0.11, 0.78]

1 Improvement in symptoms (patient assessment)

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Vaginal pH (decrease) Show forest plot

1

146

Mean Difference (IV, Fixed, 95% CI)

‐0.20 [‐0.38, ‐0.02]

3 Physical appearance of vagina (physician assessment of cure) Show forest plot

2

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Atrophy (improvement)

2

397

Odds Ratio (M‐H, Fixed, 95% CI)

1.49 [0.92, 2.42]

3.2 Pallor (improvement)

1

146

Odds Ratio (M‐H, Fixed, 95% CI)

2.56 [0.94, 6.95]

3.3 Petechiae (improvement)

1

146

Odds Ratio (M‐H, Fixed, 95% CI)

0.62 [0.12, 3.13]

3.4 Friability (improvement)

1

146

Odds Ratio (M‐H, Fixed, 95% CI)

2.37 [0.56, 9.92]

3.5 Dryness (improvement)

1

146

Odds Ratio (M‐H, Fixed, 95% CI)

7.14 [0.72, 70.65]

4 Symptom improvement or cure (patient assessment) Show forest plot

3

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 Vaginal dryness

2

397

Odds Ratio (M‐H, Fixed, 95% CI)

0.40 [0.24, 0.64]

4.2 Pruritis

2

316

Odds Ratio (M‐H, Fixed, 95% CI)

1.59 [0.85, 2.99]

4.3 Dyspareunia

3

567

Odds Ratio (M‐H, Fixed, 95% CI)

0.53 [0.36, 0.78]

4.4 Dysuria

2

421

Odds Ratio (M‐H, Fixed, 95% CI)

1.16 [0.72, 1.87]

4.5 Nocturia

1

251

Odds Ratio (M‐H, Fixed, 95% CI)

0.71 [0.40, 1.24]

4.6 Urgency

2

421

Odds Ratio (M‐H, Fixed, 95% CI)

0.79 [0.51, 1.22]

4.7 Frequency

2

421

Odds Ratio (M‐H, Fixed, 95% CI)

0.63 [0.41, 0.95]

4.8 Urge incontinence

1

251

Odds Ratio (M‐H, Fixed, 95% CI)

0.80 [0.46, 1.40]

4.9 Stress incontinence

1

251

Odds Ratio (M‐H, Fixed, 95% CI)

0.63 [0.37, 1.09]

4.10 atrophy(symptom free)

1

170

Odds Ratio (M‐H, Fixed, 95% CI)

1.18 [0.62, 2.27]

5 Adherence to treatment Show forest plot

1

146

Odds Ratio (M‐H, Fixed, 95% CI)

1.69 [0.66, 4.31]

6 Withdrawal because of adverse events Show forest plot

1

251

Odds Ratio (M‐H, Fixed, 95% CI)

1.47 [0.34, 6.30]

7 Proportion with separate adverse events Show forest plot

4

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 Vaginal discomfort

1

251

Odds Ratio (M‐H, Fixed, 95% CI)

0.38 [0.14, 1.02]

7.2 Leukorrhea

1

251

Odds Ratio (M‐H, Fixed, 95% CI)

0.87 [0.29, 2.55]

7.3 Vaginal itching

2

397

Odds Ratio (M‐H, Fixed, 95% CI)

0.75 [0.20, 2.84]

7.4 Breast pain

3

587

Odds Ratio (M‐H, Fixed, 95% CI)

0.35 [0.10, 1.28]

7.5 Vaginal haemorrhage

2

397

Odds Ratio (M‐H, Fixed, 95% CI)

0.51 [0.10, 2.55]

7.6 Weight increase

1

251

Odds Ratio (M‐H, Fixed, 95% CI)

0.58 [0.09, 3.51]

7.7 Breast discharge

1

251

Odds Ratio (M‐H, Fixed, 95% CI)

0.29 [0.03, 2.78]

7.8 Abdominal pain

2

397

Odds Ratio (M‐H, Fixed, 95% CI)

2.70 [0.31, 23.84]

7.9 Nausea

2

397

Odds Ratio (M‐H, Fixed, 95% CI)

1.02 [0.18, 5.67]

7.10 Headache

2

441

Odds Ratio (M‐H, Fixed, 95% CI)

4.83 [0.58, 40.35]

7.11 Pruritis

2

397

Odds Ratio (M‐H, Fixed, 95% CI)

1.92 [0.20, 18.59]

7.12 Flushing

2

397

Odds Ratio (M‐H, Fixed, 95% CI)

1.92 [0.20, 18.59]

7.13 Urinary urgency

1

251

Odds Ratio (M‐H, Fixed, 95% CI)

2.64 [0.11, 65.44]

7.14 Change in body smell

1

251

Odds Ratio (M‐H, Fixed, 95% CI)

0.29 [0.01, 7.16]

7.15 Malaise

1

251

Odds Ratio (M‐H, Fixed, 95% CI)

0.29 [0.01, 7.16]

7.16 Hypertrichosis

1

251

Odds Ratio (M‐H, Fixed, 95% CI)

0.29 [0.01, 7.16]

7.17 Stranguria

1

251

Odds Ratio (M‐H, Fixed, 95% CI)

2.64 [0.11, 65.44]

7.18 Oedema

2

397

Odds Ratio (M‐H, Fixed, 95% CI)

1.92 [0.20, 18.59]

7.19 Palpitation

1

251

Odds Ratio (M‐H, Fixed, 95% CI)

2.64 [0.11, 65.44]

7.20 Increased sweating

1

251

Odds Ratio (M‐H, Fixed, 95% CI)

2.64 [0.11, 65.44]

7.21 Uterine discomfort

1

251

Odds Ratio (M‐H, Fixed, 95% CI)

0.29 [0.01, 7.16]

7.22 Amnesia

1

251

Odds Ratio (M‐H, Fixed, 95% CI)

0.29 [0.01, 7.16]

7.23 Pelvic inflammation

1

251

Odds Ratio (M‐H, Fixed, 95% CI)

2.64 [0.11, 65.44]

7.24 Depression

1

190

Odds Ratio (M‐H, Fixed, 95% CI)

2.47 [0.12, 52.24]

7.25 Disturbed sleep

1

146

Odds Ratio (M‐H, Fixed, 95% CI)

0.15 [0.01, 3.66]

7.26 Diarrhea

1

146

Odds Ratio (M‐H, Fixed, 95% CI)

1.36 [0.05, 33.98]

7.27 Ulcus ventriculi

1

146

Odds Ratio (M‐H, Fixed, 95% CI)

1.36 [0.05, 33.98]

7.28 Arthralgia

1

146

Odds Ratio (M‐H, Fixed, 95% CI)

0.15 [0.01, 3.66]

7.29 Leg cramps

1

146

Odds Ratio (M‐H, Fixed, 95% CI)

0.15 [0.01, 3.66]

7.30 Pain in leg

1

146

Odds Ratio (M‐H, Fixed, 95% CI)

1.36 [0.05, 33.98]

7.31 Vulval disorder

1

146

Odds Ratio (M‐H, Fixed, 95% CI)

0.15 [0.01, 3.66]

7.32 Feeling of heat in vagina

1

146

Odds Ratio (M‐H, Fixed, 95% CI)

0.44 [0.03, 7.20]

7.33 Urinary tract infection

1

146

Odds Ratio (M‐H, Fixed, 95% CI)

1.81 [0.20, 16.71]

7.34 Candidiasis

1

146

Odds Ratio (M‐H, Fixed, 95% CI)

1.36 [0.05, 33.98]

7.35 Pressure in vagina

1

146

Odds Ratio (M‐H, Fixed, 95% CI)

3.23 [0.16, 63.91]

7.36 Breast enlargement

1

146

Odds Ratio (M‐H, Fixed, 95% CI)

0.44 [0.03, 7.20]

7.37 Anorexia

1

146

Odds Ratio (M‐H, Fixed, 95% CI)

1.36 [0.05, 33.98]

7.38 Cold

1

146

Odds Ratio (M‐H, Fixed, 95% CI)

1.36 [0.05, 33.98]

7.39 Dry cough

1

146

Odds Ratio (M‐H, Fixed, 95% CI)

1.36 [0.05, 33.98]

7.40 Fever and pain on left side

1

146

Odds Ratio (M‐H, Fixed, 95% CI)

1.36 [0.05, 33.98]

7.41 Impairment of hearing

1

146

Odds Ratio (M‐H, Fixed, 95% CI)

1.36 [0.05, 33.98]

7.42 Viral infection

1

146

Odds Ratio (M‐H, Fixed, 95% CI)

1.36 [0.05, 33.98]

7.43 Migraine

1

146

Odds Ratio (M‐H, Fixed, 95% CI)

1.36 [0.05, 33.98]

7.44 Pneumonia

1

146

Odds Ratio (M‐H, Fixed, 95% CI)

1.36 [0.05, 33.98]

7.45 Polyuria

1

146

Odds Ratio (M‐H, Fixed, 95% CI)

1.36 [0.05, 33.98]

7.46 vaginal irritation

2

360

Odds Ratio (M‐H, Fixed, 95% CI)

1.17 [0.44, 3.12]

7.47 vaginal erythema

1

170

Odds Ratio (M‐H, Fixed, 95% CI)

0.67 [0.22, 2.02]

7.48 Bleeding during treatment

1

170

Odds Ratio (M‐H, Fixed, 95% CI)

1.57 [0.06, 39.25]

7.49 vaginal ulceration

1

170

Odds Ratio (M‐H, Fixed, 95% CI)

2.65 [0.13, 56.05]

8 Acceptability of treatment delivery system (excellent or good) Show forest plot

4

698

Odds Ratio (M‐H, Fixed, 95% CI)

4.55 [3.17, 6.53]

9 Improvement in cytology (3 weeks) Show forest plot

1

154

Odds Ratio (M‐H, Fixed, 95% CI)

5.33 [2.56, 11.09]

10 Plasma estradiol levels (pmol/L) at 48 weeks Show forest plot

1

146

Mean Difference (IV, Fixed, 95% CI)

‐16.0 [‐31.74, ‐0.26]

1 Karyopyknotic index (increased) Show forest plot

1

48

Mean Difference (IV, Fixed, 95% CI)

‐1.87 [‐17.61, 13.87]

2 Maturation value (increased) Show forest plot

1

48

Mean Difference (IV, Fixed, 95% CI)

‐4.69 [‐13.58, 4.20]

3 Endometrial thickness (increased) Show forest plot

1

48

Mean Difference (IV, Fixed, 95% CI)

‐0.30 [‐0.82, 0.22]

4 Vaginal health index (improvement) Show forest plot

1

48

Mean Difference (IV, Fixed, 95% CI)

0.40 [‐0.79, 1.59]

5 Vaginal pH (decreased) Show forest plot

1

48

Mean Difference (IV, Fixed, 95% CI)

0.20 [‐0.12, 0.52]

6 Proliferative endometrium Show forest plot

2

151

Odds Ratio (M‐H, Fixed, 95% CI)

0.23 [0.05, 1.11]

7 Endometrial hyperplasia Show forest plot

1

98

Odds Ratio (M‐H, Fixed, 95% CI)

0.19 [0.01, 4.10]

8 Symptom improvement (patient assessment) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

8.1 dryness

1

130

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.24, 0.24]

8.2 soreness

1

130

Mean Difference (IV, Fixed, 95% CI)

‐0.10 [‐0.29, 0.09]

8.3 irritation

1

130

Mean Difference (IV, Fixed, 95% CI)

‐0.10 [‐0.33, 0.13]

9 Symptom improvement (patient assessment) Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 burning, pain

1

48

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

9.2 dsypareunia

1

48

Odds Ratio (M‐H, Fixed, 95% CI)

3.5 [0.80, 15.34]

9.3 frequency

1

48

Odds Ratio (M‐H, Fixed, 95% CI)

0.54 [0.11, 2.58]

9.4 nocturia

1

48

Odds Ratio (M‐H, Fixed, 95% CI)

1.0 [0.32, 3.11]

9.5 stress incontinence

1

48

Odds Ratio (M‐H, Fixed, 95% CI)

0.84 [0.27, 2.64]

9.6 dryness

1

48

Odds Ratio (M‐H, Fixed, 95% CI)

7.0 [1.64, 29.85]

10 Symptom improvement (physican assessment) Show forest plot

1

128

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.27, 0.27]

10.1 atrophy

1

128

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.27, 0.27]

11 Adherence to treatment/participation levels Show forest plot

2

212

Odds Ratio (M‐H, Fixed, 95% CI)

3.48 [1.64, 7.38]

12 Withdrawal because of adverse effects Show forest plot

1

159

Odds Ratio (M‐H, Fixed, 95% CI)

0.24 [0.08, 0.78]

13 Proportion with separate adverse effects Show forest plot

2

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

13.1 uterine bleeding, breast pain, perineal pain

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

13.2 pelvic discomfort

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

14 Acceptability of treatment Show forest plot

2

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

14.1 ease of administration(easy)

1

126

Odds Ratio (M‐H, Fixed, 95% CI)

5.04 [1.93, 13.15]

14.2 comfort of administration(comfortable)

1

126

Odds Ratio (M‐H, Fixed, 95% CI)

9.29 [3.61, 23.88]

14.3 overall acceptability(very acceptable)

1

126

Odds Ratio (M‐H, Fixed, 95% CI)

8.57 [3.82, 19.25]

14.4 satisfaction

1

53

Odds Ratio (M‐H, Fixed, 95% CI)

2.12 [0.54, 8.34]

15 Plasma estradiol levels at 12 weeks(pg/ml) Show forest plot

1

48

Mean Difference (IV, Fixed, 95% CI)

‐3.70 [‐9.53, 2.13]

16 Increased E2 levels(24 weeks) Show forest plot

1

98

Odds Ratio (M‐H, Fixed, 95% CI)

0.09 [0.02, 0.32]

1 Vaginal dryness index (improvement) Show forest plot

1

37

Mean Difference (IV, Fixed, 95% CI)

4.46 [2.76, 6.16]

2 Vaginal pH (decreased) Show forest plot

2

62

Mean Difference (IV, Fixed, 95% CI)

‐0.36 [‐0.52, ‐0.21]

3 Lack of itching Show forest plot

1

36

Odds Ratio (M‐H, Fixed, 95% CI)

4.27 [0.43, 42.63]

4 Lack of dyspareunia Show forest plot

1

37

Odds Ratio (M‐H, Fixed, 95% CI)

2.17 [0.57, 8.26]

5 Overall feeling (good, very good, excellent) Show forest plot

1

39

Odds Ratio (M‐H, Fixed, 95% CI)

3.56 [0.77, 16.31]

6 Adverse events Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 abdominal pain

1

39

Odds Ratio (M‐H, Fixed, 95% CI)

3.32 [0.13, 86.75]

6.2 vaginal odour

1

39

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 8.70]

7 Vaginal moisture Show forest plot

1

60

Mean Difference (IV, Fixed, 95% CI)

1.04 [0.77, 1.31]

8 Vaginal fluid volume Show forest plot

1

60

Mean Difference (IV, Fixed, 95% CI)

1.04 [0.74, 1.34]

9 Vaginal elasticity Show forest plot

1

60

Mean Difference (IV, Fixed, 95% CI)

1.1 [0.79, 1.41]

1 Vaginal dryness score

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Maturation (high or medium) Show forest plot

1

79

Odds Ratio (M‐H, Fixed, 95% CI)

1.83 [0.59, 5.66]

3 Adverse effects (individual) Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 itching

1

96

Odds Ratio (M‐H, Fixed, 95% CI)

2.04 [0.18, 23.32]

3.2 discomfort

1

96

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 8.22]

3.3 breast pain

1

96

Odds Ratio (M‐H, Fixed, 95% CI)

3.06 [0.12, 77.09]

3.4 abdominal pain

1

96

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 8.22]

3.5 paresthesia

1

96

Odds Ratio (M‐H, Fixed, 95% CI)

1.0 [0.06, 16.46]

3.6 nausea

1

96

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 8.22]

3.7 insomnia

1

96

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 8.22]

4 Leakage of medication Show forest plot

1

96

Odds Ratio (M‐H, Fixed, 95% CI)

0.04 [0.01, 0.14]

5 Requirement for sanitary wear Show forest plot

1

96

Odds Ratio (M‐H, Fixed, 95% CI)

0.02 [0.00, 0.43]

6 Incontinence Show forest plot

1

2

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Withdrawal due to adverse events Show forest plot

1

96

Odds Ratio (M‐H, Fixed, 95% CI)

7.46 [0.37, 148.48]

8 Ease of use Show forest plot

1

96

Odds Ratio (M‐H, Fixed, 95% CI)

2.69 [1.15, 6.31]

9 Hygenic treatment Show forest plot

1

96

Odds Ratio (M‐H, Fixed, 95% CI)

2.26 [0.71, 7.21]

1 Maturation value

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Vaginal pH (decreased) Show forest plot

1

2

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Endometrial thickness

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Free of symptoms (physician assessment) Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.2 pallor

1

52

Odds Ratio (M‐H, Fixed, 95% CI)

4.88 [1.32, 18.05]

4.3 petechiae

1

35

Odds Ratio (M‐H, Fixed, 95% CI)

2.06 [0.38, 11.04]

4.4 friability

1

41

Odds Ratio (M‐H, Fixed, 95% CI)

7.33 [1.63, 33.08]

4.5 vaginal dryness

1

65

Odds Ratio (M‐H, Fixed, 95% CI)

0.83 [0.28, 2.41]

5 Symptom improvement (patient assesment) Show forest plot

1

67

Odds Ratio (M‐H, Fixed, 95% CI)

12.67 [3.23, 49.66]

1 Urogenital index score

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Vaginal pH

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Hyperplasia Show forest plot

1

50

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Vaginal atrophy (moderate/severe) Show forest plot

1

154

Odds Ratio (M‐H, Fixed, 95% CI)

0.27 [0.11, 0.66]

5 Vaginal dryness (moderate/severe) Show forest plot

1

154

Odds Ratio (M‐H, Fixed, 95% CI)

0.45 [0.20, 1.00]

6 Burning/itching (moderate/severe) Show forest plot

1

154

Odds Ratio (M‐H, Fixed, 95% CI)

0.35 [0.14, 0.86]

7 Dyspareunia (moderate/severe) Show forest plot

1

150

Odds Ratio (M‐H, Fixed, 95% CI)

0.26 [0.10, 0.69]

8 Adverse effects Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 dizziness

1

154

Odds Ratio (M‐H, Fixed, 95% CI)

3.20 [0.13, 79.82]

8.2 gastric pain

1

154

Odds Ratio (M‐H, Fixed, 95% CI)

3.20 [0.13, 79.82]

8.3 perineal rash

1

154

Odds Ratio (M‐H, Fixed, 95% CI)

1.05 [0.06, 17.16]

8.4 genital pain

1

154

Odds Ratio (M‐H, Fixed, 95% CI)

1.05 [0.06, 17.16]

8.5 alopecia

1

154

Odds Ratio (M‐H, Fixed, 95% CI)

3.20 [0.13, 79.82]

8.6 smell

1

154

Odds Ratio (M‐H, Fixed, 95% CI)

3.20 [0.13, 79.82]

8.7 psoriasis

1

154

Odds Ratio (M‐H, Fixed, 95% CI)

3.20 [0.13, 79.82]

8.8 increase in weight

1

154

Odds Ratio (M‐H, Fixed, 95% CI)

0.21 [0.01, 4.35]

8.9 burning/itching

1

154

Odds Ratio (M‐H, Fixed, 95% CI)

0.21 [0.01, 4.35]

8.10 leg cramps

1

154

Odds Ratio (M‐H, Fixed, 95% CI)

0.35 [0.01, 8.64]

8.11 leg itching

1

154

Odds Ratio (M‐H, Fixed, 95% CI)

0.35 [0.01, 8.64]

8.12 sweating

1

154

Odds Ratio (M‐H, Fixed, 95% CI)

0.35 [0.01, 8.64]

8.13 period palpitations

1

154

Odds Ratio (M‐H, Fixed, 95% CI)

0.35 [0.01, 8.64]

8.14 discharge(vaginal)

1

154

Odds Ratio (M‐H, Fixed, 95% CI)

0.35 [0.01, 8.64]

9 Improvement of symptoms Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 loss of libido

1

26

Odds Ratio (M‐H, Fixed, 95% CI)

2.18 [0.17, 27.56]

9.2 vaginitis

1

26

Odds Ratio (M‐H, Fixed, 95% CI)

3.24 [0.12, 87.13]

9.3 dyspareunia

1

26

Odds Ratio (M‐H, Fixed, 95% CI)

3.24 [0.12, 87.13]

10 Improvement in symptoms (physician assessment) Show forest plot

1

26

Odds Ratio (M‐H, Fixed, 95% CI)

2.63 [0.53, 13.07]

11 Improvement in symptoms (patient asssessment) Show forest plot

1

26

Odds Ratio (M‐H, Fixed, 95% CI)

1.87 [0.39, 8.89]