How to relieve vaginal dryness

Q: Since menopause, I've noticed dryness and itching “down there.” Is there anything besides hormone pills that can help?

Vaginal dryness and discomfort affect over 75% of post-menopausal women. These symptoms also commonly affect women taking anti-estrogen medicines for breast cancer.

Without estrogen, the vagina and birth canal cells shrink or atrophy. They lose elasticity and secrete less lubricating fluid. This leads to vaginal dryness, itching, and burning. When a woman loses the lubrication of vaginal secretions, sexual activity can become quite painful.

Vaginal secretions are crucial to a healthy vaginal environment. They help create and maintain an optimal level of acidity in the vagina. This vaginal acidity supports the growth of "friendly" bacteria like lactobacillus and discourages yeast and certain bacterial infections.

The distress of vaginal discomfort and dryness can be relieved in several ways. You can apply a long-acting moisturizer, use a personal lubricant, or add estrogen to your vaginal tissue.

Replens® is a long-acting moisturizing gel that works for up to 3 days at a time. It's available without a prescription in 2 different forms. You can choose premeasured doses inside individual plastic applicators or one tube with a reusable applicator.

Vaginal moisturizers can relieve dryness and burning and make sexual intercourse more comfortable. However, a moisturizer alone won’t reverse the changes in your vaginal cells, optimize the acidity of your vagina, or restore helpful lactobacillus.

Newer vaginal moisturizers contain hyaluronic acid for long-lasting moisture, plus a mild acid to support vaginal acidity. Hyaluronic acid is as effective as low-dose estrogen vaginal cream in relieving dryness, burning, and painful sexual activity.

Vaginal lubricants differ from moisturizers and often contain silicones, oils, fragrances, and flavors. Lubricants ease symptoms of dryness and increase the comfort of sexual activity but do not optimize vaginal acid balance or encourage lactobacillus.

Applying a small amount of estrogen directly to vaginal cells restores their elasticity, acidity, and ability to secrete a lubricating fluid. This encourages beneficial lactobacillus while reducing dryness and burning.

Can breast cancer survivors safely use a low dose of vaginal estrogen to relieve vaginal discomfort? The evidence suggests YES. When applied directly to vaginal cells, a little estrogen can make a big difference in comfort. When used at appropriate doses, vaginal estrogen doesn't create detectable levels in the bloodstream. It is unlikely to affect endometrial and breast tissue.

There are several forms of local estrogen: vaginal creams used with an applicator (Premarin®, Estrace® or generic estradiol), vaginal tablets with individual applicators (Vagifem®), and a gelatin ring that slowly releases estrogen (Estring®). The starting dose for estrogen creams and vaginal tablets is once daily at bedtime for 1-2 weeks, then twice weekly. Estring® is a flexible estrogen ring inserted vaginally and replaced every 90 days.

Other prescription-only options for vaginal discomfort include Osphena® and Intrarosa®. Osphena® tablets mimic the effects of estrogen in vaginal tissue but block estrogen’s action in breast tissue.

Intrarosa® is a prescription medicine that contains DHEA (dehydroepiandrosterone). One tablet is inserted vaginally at bedtime. Intrarosa® is more effective at relieving vaginal dryness than other supplements containing DHEA.

Contact your doctor if you suffer from vaginal discomfort. If infection or another condition is not the cause, ask whether low-dose vaginal estrogen or another medicine is an option for you.

Here Are 6 Tips to Help Relieve Vaginal Discomfort:

1.         Be consistent.

For best results, reapply vaginal moisturizers and estrogen frequently. Many vaginal estrogen products are applied twice weekly, and long-acting vaginal moisturizers can last up to 3 days.

2.         Shop online if needed.

Although Replens® and Vagisil® moisturizers are available in most grocery stores and pharmacies, vaginal moisturizers containing hyaluronic acids like Good Clean Love’s Bionourish® and Revaree® manufactured by Bonafide are harder to find.

3.         More can be better.

You can use a vaginal moisturizer in addition to locally applied estrogen to get more relief. For best results, apply moisturizer and estrogen on alternating days.

4.         Add a personal lubricant.

Try a personal lubricant if sexual contact is uncomfortable despite using a vaginal moisturizer with or without low-dose estrogen. There are many choices available today besides the old standby, K-Y Jelly®.

5.         Know your options.

Discuss your options for vaginal estrogen and other medicines to relieve vaginal dryness with your doctor.

6.         Shop around.

Even with insurance, prescription options for relieving vaginal discomfort are often expensive. A 90-day prescription of generic estradiol vaginal cream can be $60 in cash. A 3-month supply of other estrogen products like Premarin® cream, vaginal tablets, Estring® vaginal ring, Intrarosa®, and Osphena® can cost over $400.

Dr. Louise Achey, Doctor of Pharmacy, is a 44-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog, TheMedicationInsider.com.

Ó2023 Louise Achey