Tackling the Issue of Vaginal Dryness
Postmenopausal women often have a variety of concerns and problems that can result from the changes in their hormone levels. Margaret Polaneczky, MD, a gynecologist at the Iris Cantor Women’s Health Center at Weill Cornell Medicine, says that vaginal dryness is one of the most common complaints among postmenopausal women.
Moisturize and Lubricate
“One of the consequences of menopause is vaginal dryness—a lack of lubrication that, for many women, means painful sex. Many of my patients ask if there’s anything that can be done to get back the sex life she and her partner once enjoyed. Fortunately, the answer is almost always “Yes,’” says Dr. Polaneczky.
The first step for most women is a trial of non-hormonal therapy. You’ll need two things: a moisturizer and a lubricant.
“The menopausal vagina needs moisturizer, just like aging skin does. It doesn’t have to be every day, but it has to be regular and consistent. I don’t promote products, but I do tell my patients about Replens—it’s been studied and shown to be as effective as vaginal estrogen in restoring the premenopausal vaginal mucosa. Have fun with lubricants—try out different brands, but avoid flavored and scented products if you’re sensitive to them,” advises Dr. Polaneczky.
WHAT YOU SHOULD KNOW
▶ In 2013, the FDA approved ospemifine (Osphena) to treat menopausal vaginal dryness. In the vagina, ospemifine acts like estrogen, restoring vaginal moisture and the integrity of the vaginal mucosa.
▶ Like oral estrogens, ospemiphene carries a small blood clot risk, although it is lower than the risk associated with hormone replacement therapy.
▶ Ospemiphene may cause hot flashes, but they generally subside after about four weeks of use.
If it’s been awhile since you’ve had sex, don’t start treatment and then expect to be hit by a sudden urge to have sex. “Your libido is not going to suddenly turn back on just because your vagina is ready. Have sex anyway, whether you think you want to or not. If all goes well, your body will respond and enjoy the experience,” says Dr. Polaneczky.
Vaginal Estrogen
You can also consider using vaginal estrogen, which works by restoring and thickening the vaginal mucosa and by increasing vaginal secretions.
Vaginal estrogen comes in three forms:
Estradiol tablets (Vagifem): This is a small tablet that is inserted into the vagina once a night for two weeks, then twice a week thereafter. For many women, the tablet is the easiest and least messy option, although some women have trouble remembering to use it.
Estrogen creams: These include Estrace, its generics, and Premarin. The cream is inserted into the vagina once a night for two weeks, then twice a week thereafter. Again, some women forget to use it once they’re past the initial two-week period. “In the cream, the estrogen doses are highest when used according to the package insert, but you can adjust the dose of cream by simply using less. This allows for higher doses at the onset of treatment, with lower maintenance doses once vaginal integrity and sexual function are restored,” explains Dr. Polaneczky.
Estradiol vaginal ring (Estring): This is a flexible ring that is inserted into the vagina once every three months and continuously releases small doses of estrogen. Using the ring eliminates the issue of remembering to use a product, but Dr. Polaneczky notes that not all women’s vaginas are large enough to accommodate the ring. In that case, start with the vaginal estrogen tablets or cream. Over time, and with resumption of intercourse, the vaginal capacity may increase enough to accommodate the vaginal ring.
Safety Concerns
Many women immediately become concerned when they hear the word “estrogen” due to study findings that taking oral hormone replacement therapy (HRT) is associated with a small increase in breast cancer risk. However, Dr. Polaneczky explains that estrogen exposure from use of vaginal estrogen is much lower than that with HRT, and blood levels of estrogen remain within the menopausal range.
“The small amounts of estrogen in vaginal products do not carry the same risks of blood clots as does HRT, and there is no increase in uterine cancer rates with vaginal estrogen use for up to five years,” says Dr. Polaneczky. “That said, we do not have long-term data on breast cancer risks from vaginal estrogen, and women at high risk for breast cancer or with a history of breast cancer generally want to avoid even small amounts of estrogen.”
The bottom line: Having vaginal dryness doesn’t mean your sex life is over; have a frank discussion with your gynecologist if you need more guidance on the treatment options that are available.
Dr. Polaneczky’s final recommendation: “Keep having sex. The old adage ‘Use it or lose it’ really does apply here. Sexual activity (even masturbation) increases blood flow to the vaginal tissues, which helps lubrication.”
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