To treat genitourinary syndrome of menopause (GSM), your doctor may first recommend that you:
- Try a vaginal moisturizer (Replens, Vagisil Feminine Moisturizer, Hyalo Gyn, others) to restore some moisture to your vaginal area. You may have to apply the moisturizer every two to three days. The effects of a moisturizer generally last a little longer than those of a lubricant.
- Use a water-based lubricant (glycerin-free versions of Astroglide, K-Y Touch, others) to reduce discomfort during intercourse. Choose products that don't contain glycerin because women who are sensitive to this chemical may experience burning and irritation. Avoid petroleum jelly or other petroleum-based products for lubrication if you're also using condoms. Petroleum can break down latex condoms on contact.
Bothersome symptoms that don't improve with over-the-counter treatments may be helped by:
- Topical (vaginal) estrogen. Vaginal estrogen has the advantage of being effective at lower doses and limiting your overall exposure to estrogen because less reaches your bloodstream. It may also provide better direct relief of symptoms than oral estrogen does.
- Oral estrogen. Estrogen taken by mouth enters your entire system. Ask your doctor to explain the risks vs. the benefits of oral estrogen.
Vaginal estrogen therapy comes in several forms. Because they all seem to work equally well, you and your doctor can decide which one is best for you.
- Vaginal estrogen cream. 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. Typically women use it daily for one to three weeks and then one to three times a week thereafter. Although creams may offer faster relief than do other forms of vaginal estrogen, they can be messier.
- Vaginal estrogen ring. You or your doctor inserts a soft, flexible ring into the upper part of the vagina. The ring releases a consistent dose of estrogen while in place and needs to be replaced about every three months. Many women like the convenience this offers. A different, higher dose ring is considered a systemic rather than topical treatment.
- Vaginal estrogen tablet. You use a disposable applicator to place a vaginal estrogen tablet in your vagina. Your doctor will let you know how often to insert the tablet. You might, for instance, use it daily for the first two weeks and then twice a week thereafter.
Systemic estrogen therapy
If vaginal dryness is associated with other symptoms of menopause, such as moderate or severe hot flashes, your doctor may suggest estrogen pills, patches or gel, or a higher dose estrogen ring.
Your doctor will prescribe progestin along with estrogen if you haven't had your uterus removed (hysterectomy). Oral progesterone, which is chemically identical to the hormone your body produces (bioidentical), is often preferred. Combination estrogen-progestin patches also are available.
If you don't have a uterus, estrogen alone can be used. Talk with your doctor to decide if hormone treatment is an option for you, taking into account any medical issues and family medical history.
Researchers are working to develop other treatments for GSM because of concerns about the long-term potential for even small doses of estrogen to increase the risk of breast and endometrial cancer.
If you've had breast cancer
If you have a history of breast cancer, tell your doctor and consider these issues:
- Nonhormonal treatments. Try moisturizers and lubricants as a first choice.
- Vaginal estrogen. In consultation with your cancer specialist (oncologist), your doctor might recommend low-dose vaginal estrogen if nonhormonal treatments don't help your symptoms. However, there's some concern that vaginal estrogen might increase your risk of the cancer coming back, especially if your breast cancer was hormonally sensitive.
- Systemic estrogen therapy. Systemic estrogen treatment generally isn't recommended, especially if your breast cancer was hormonally sensitive.
Some alternative medicines are used to treat vaginal dryness and irritation associated with menopause, but few approaches are backed by evidence from clinical trials. Interest in complementary and alternative medicine is growing, and researchers are working to determine the benefits and risks of various alternative treatments for genitourinary syndrome of menopause.
Talk with your doctor before taking any herbal or dietary supplements for perimenopausal or menopausal symptoms. The Food and Drug Administration doesn't regulate herbal products, and some can be dangerous or interact with other medications you take, putting your health at risk.