In general, treating vaginal dryness is more effective with topical (vaginal) estrogen rather than systemic estrogen given orally or by skin patch. Estrogen applied to the vagina can still result in estrogen reaching your bloodstream, but the amount is minimal, especially if a low dose is used.
Vaginal estrogen doesn't decrease testosterone levels — important for healthy sexual function — the same way oral estrogen can. Vaginal estrogen therapy may also reduce the risk of urinary tract infections.
Talk with your doctor about what dose and what product is appropriate for you. Vaginal estrogen therapy comes in several forms:
- Vaginal estrogen cream (Estrace, Premarin, others). You insert this cream directly into your vagina with an applicator, usually at bedtime. Your doctor will let you know how much cream to use and how often to insert it.
- Vaginal estrogen ring (Estring). A soft, flexible ring is inserted into the upper part of the vagina by you or your doctor. The ring releases a consistent dose of estrogen while in place and needs to be replaced about every three months.
- Vaginal estrogen tablet (Vagifem). You use a disposable applicator to place a vaginal estrogen tablet into your vagina. Your doctor will tell you how often to insert the tablet.
If vaginal dryness is associated with other symptoms of menopause, such as moderate or severe hot flashes, your doctor may suggest systemic estrogen, along with a progestin if you have not had your uterus removed (hysterectomy). Systemic estrogen can be given as pills, patches, gel or a higher dose estrogen ring.
Talk to your doctor to decide if hormone treatment is an option and, if so, which type is best for you. If you have a history of breast, ovarian or cervical cancer, vaginal estrogen therapy may still be an option, but discuss the risks and benefits with your doctor.
Dec. 21, 2012
- Bachmann G, et al. Clinical manifestations and diagnosis of vaginal atrophy. http://www.uptodate.com/index. Accessed Oct. 31, 2012.
- Casper RF. Clinical manifestations and diagnosis of menopause. http://www.uptodate.com/index. Accessed Oct. 31, 2012.
- The North American Menopause Society. The 2012 hormone therapy position statement of The North American Menopause Society. Menopause. 2012;19:257.
- Bachmann G, et al. Treatment of vaginal atrophy. http://www.uptodate.com/index. Accessed Oct. 31, 2012.
- Fox R, et al. Treatment of dry mouth and other non-ocular symptoms of Sjogren's syndrome. http://www.uptodate.com/index. Accessed Oct. 31, 2012.
- Frequently asked questions. Women's health FAQ072. Your sexual health. American College of Obstetricians and Gynecologists. http://www.acog.org/~/media/For%20Patients/faq072.pdf?dmc=1&ts=20121214T1150341035. Accessed Oct. 31, 2012.
- MenoNote: Vaginal dryness. The North American Menopause Society. http://www.menopause.org/publications/educational-materials-for-women/menonotes. Accessed Oct. 31, 2012.
- Vaginal and vulvar comfort: Lubricants, moisturizers, and low-dose vaginal estrogen. The North American Menopause Society. http://www.menopause.org/for-women/-em-sexual-health-menopause-em-online/effective-treatments-for-sexual-problems/vaginal-and-vulvar-comfort-lubricants-moisturizers-and-low-dose-vaginal-estrogen. Accessed Oct. 31, 2012.
- Cano A, et al. The therapeutic effect of a new ultra low concentration estriol gel formulation (0.005% estriol vaginal gel) on symptoms and signs of postmenopausal vaginal atrophy: Results from a pivotal phase III study. Menopause. 2012;19:1130.
- Frequently asked questions. Gynecologic problems FAQ028. Vaginitis. The American College of Obstetricians and Gynecologists. http://www.acog.org/~/media/For%20Patients/faq028.pdf?dmc=1&ts=20121214T1156584804. Accessed Oct. 31, 2012.
- Marnach ML (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 6, 2012.
- Gallenberg MM (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 3, 2012.