What medication is recommended to treat atrophic vaginitis in postmenopausal patients?

Topical estrogen (such as Estrace cream) is the recommended medication for treating atrophic vaginitis in postmenopausal patients because it directly addresses the underlying cause of the condition, which is a decline in estrogen levels. After menopause, decreased estrogen leads to thinning, drying, and inflammation of the vaginal tissues, manifesting as symptoms like dryness, irritation, and discomfort during intercourse.

Topical estrogen therapy works by replenishing estrogen levels in vaginal tissues, helping to restore the normal structure and function of the vaginal epithelium. This local treatment minimizes systemic exposure and side effects compared to oral estrogen, making it a preferred choice for managing atrophic vaginitis specifically.

In contrast, other medications listed do not target the root cause of atrophic vaginitis. Topical hydrocortisone is typically used to reduce inflammation and itching but does not address the estrogen deficiency. Metronidazole is an antibiotic and is useful for treating bacterial infections, not for hormonal or atrophic conditions. Terconazole is an antifungal medication used to treat yeast infections and does not have any beneficial effects on atrophic vaginitis. Therefore, topical estrogen is the most appropriate and effective treatment option for this condition.