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Treatments and drugs
By Mayo Clinic staff
Vaginal estrogen therapy
In general, treating vaginal dryness is more effective with topical (vaginal) estrogen rather than oral estrogen. Estrogen applied to the vagina can still result in estrogen reaching your bloodstream, but the amount is minimal. Vaginal estrogen also doesn't decrease testosterone levels — important for healthy sexual function — the same way oral estrogen can.
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, usually a daily regimen for the first few weeks and then two or three times a week thereafter.
- 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 in your vagina. Your doctor will let you know how often to insert the tablet, for instance daily for the first two weeks and then twice a week thereafter.
If vaginal dryness is associated with other symptoms of menopause, such as moderate or severe hot flashes, your doctor may suggest estrogen pills, patches, gel or a higher dose estrogen ring along with a progestin. 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. Clinical manifestations and diagnosis of vaginal atrophy. http://www.uptodate.com/home/index.html. Accessed May 25, 2010.
- Casper RF. Clinical manifestations and diagnosis of menopause. http://www.uptodate.com/home/index.html. Accessed May 25, 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. Menopause. 2007;14:357.
- Bachmann G, et al. Treatment of vaginal atrophy. http://www.uptodate.com/home/index.html. Accessed May 26, 2010.
- Cedars MI, et al. Menopause. In: Gibbs RS, et al. Danforth's Obstetrics and Gynecology. 10th ed. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2008:725.
- Ibe C, et al. Vulvovaginal atrophy: Current and future therapies. Journal of Sexual Medicine. 2010;7:1042.
- Fox R, et al. Clinical manifestations of Sjogren's syndrome: Exocrine gland disease. http://www.uptodate.com/home/index.html. Accessed May 25, 2010.
- Vaginitis. American College of Obstetricians and Gynecologists. http://www.acog.org/publications/patient_education/bp028.cfm. Accessed May 26, 2010.
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