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Treatments and drugs
By Mayo Clinic staffMild symptoms of vaginal atrophy may be relieved by use of an over-the-counter lubricant or moisturizer.
If symptoms are bothersome, however, either topical (vaginal) or oral estrogen is effective in relieving vaginal dryness and itchiness, and improving vaginal elasticity. Vaginal estrogen has the advantage of being effective at lower doses and limiting your overall exposure to estrogen. Estrogen applied to the vagina can still result in estrogen reaching your bloodstream, but the amount is minimal. Vaginal estrogen may also provide more direct relief of symptoms.
You should experience noticeable improvements after a few weeks of estrogen therapy. Some symptoms of severe atrophy may take longer to resolve.
If you have a history of breast cancer, oral estrogen therapy generally isn't recommended as it might stimulate cancer cell growth, especially if your breast cancer was hormonally sensitive. Whether low-dose vaginal estrogen is safe for breast cancer survivors is controversial. It's not known whether even a small increase in the level of estrogen circulating in your bloodstream may increase your risk of the cancer coming back. You might choose nonhormonal treatments, such as moisturizers and lubricants, instead.
Topical estrogen
Vaginal estrogen therapy comes in several forms. Because they all seem to work equally well, you and your doctor can determine which one is best suited to your preferences.
- 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, usually a daily application for the first few weeks and then two or three times a week thereafter. Although creams may offer more immediate relief than do other forms of vaginal estrogen, they can be more messy.
- 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. Many women like the convenience this offers.
- Vaginal estrogen tablet (Vagifem). 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.
Oral 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 along with a progestin. Progestin is usually given as a pill, but combination estrogen-progestin patches also are available. Talk to your doctor to decide if hormone treatment is an option and, if so, which type is best for you.
- Bachmann G, et al. Diagnosis and treatment of vaginal atrophy. http://www.uptodate.com/patients/index.html. Accessed Aug. 6, 2010.
- The North American Menopause Society. The role of local vaginal estrogen for treatment of vaginal atrophy in postmenopausal women: 2007 position statement of The North American Menopause Society. 2007;14:357.
- MacBride MB, et al. Vulvovaginal atrophy. Mayo Clinic Proceedings. 2010;85:87.
- Palacios S. Managing urogenital atrophy. Maturitas. 2009;63:315.
- Suckling JA, et al. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database of Systematic Reviews. 2006:CD001500.
- Archer DF. Efficacy and tolerability of local estrogen therapy for urogenital atrophy. Menopause. 2010;17:194.
- Reed SD, et al. Vaginal, endometrial, and reproductive hormone findings: Randomized, placebo-controlled trial of black cohosh, multibotanical herbs and dietary soy for vasomotor symptoms: The Herbal Alternatives for Menopause (HALT) study. Menopause. 2008;15:51.
- Mehta A, et al. Vulvovaginal complaints. Clinical Obstetrics and Gynecology. 2008;51:549.
- Labrie F, et al. Intravaginal dehydroepiandrosterone (Prasterone), a physiological and highly efficient treatment of vaginal atrophy. Menopause. 2009;16:907.
- Panjari M, et al. DHEA for postmenopausal women: A review of the evidence. Maturitas. 2010;66:172.
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