Over half of women in menopause experience symptoms related to the hormonal changes associated with the decrease in estrogen levels, particularly vaginal dryness with itching and soreness, urinary symptoms and painful intercourse.
Lower levels of estrogen lead to thinning and inflammation of the vaginal walls. These chronic changes can interfere with a healthy sexual relationship and quality of life. Yet most women do not seek treatment. There is still fear from the Women’s Health Initiative (WHI) on the risks of systemic (oral pills or transdermal patches) regimens as far as any increased risk of heart disease or breast cancer.
over-the-counter non-hormonal options
Lubricants and moisturizers are most beneficial for women with mild symptoms. Lubricants are considered for short-term relief of vaginal dryness during sexual activity. These work by decreasing friction. They have a short duration of action so must be applied prior to and during each sexual encounter.
Several household oils are safe to use as both a bedside lubricant and a daily vaginal moisturizer. Check your kitchen cabinets for organic cooking oils such as coconut oil, olive oil and avocado oil. You can even use to moisturize your skin and your hair, oh and cook with as well; just purchase a dedicated bottle for personal use.
Lubricants are considered for short-term relief of vaginal dryness during sexual activity. These work by decreasing friction. They have a short duration of action so must be applied prior to and during each sexual encounter.
Just Like Me
K-Y EZ Liquid
Elegance Woman's Lubricant
Vaginal moisturizers are long-term relief of vaginal dryness. They are recommended for use several times a week and provide continuous therapy. Moisturizers are absorbed into the skin and adhere to the vaginal walls to mimic natural secretions.
prescription hormone products
Vaginal estrogen therapies have the standard treatment for menopausal-related vaginal dryness. These treatments rapidly restore vaginal tissue, improve vaginal secretions and help maintain a healthy vaginal balance (by lowering the vaginal pH) to prevent vaginal as well as urinary infections.
Estrogen helps increase lubrication and improves elasticity. Side effects of vaginal estrogen may include breast tenderness, headache, hair loss, nausea, spotting, cramps or bloating and increased vaginal discharge.
Vaginal estrogen has NOT been shown to increase the risk of breast cancer or heart disease.
creams allow for flexible dosing
may be applied externally
some women report leakage
tablets are less messy
come in a controlled dose
may not relieve external symptoms
only dosed twice a week
delivers continuous estrogen for 90 days
might be difficult to insert/remove
not useful for women with organ prolapse
DHEA hormone is transformed into estrogen and androgens (testosterone) once placed in the vagina. It does not negatively affect the lining of the uterus.
It is NOT absorbed systemically (throughout the body) so there is no effect on blood levels of estrogen or testosterone.
Prasterone (Intrarosa) is a DHEA steroid hormone. It is also FDA-approved for the treatment of moderate to severe dyspareunia (painful intercourse). It is delivered in a “fat emulsion” as a vaginal suppository which acts as a vaginal moisturizer as well.
metabolized locally in the vagina to estrogen and testosterone
not systemically absorbed
must be used daily
may cause a discharge if used during the daytime
prescription non-hormonal products
selective estrogen receptor modulators (SERMs)
Selective estrogen receptor modulators (SERMs) are non-hormonal medications that act on estrogen receptors. They block the action of estrogen in certain tissues but can mimic the action of estrogen in other tissues.
Studies did not reveal any increase risk of breast or uterine cancer.
Ospemifene (Osphena) has been FDA-approved for the treatment of moderate to severe dyspareunia (painful intercourse) by mimicking estrogen effects in the vaginal tissue. This improves the maturation of healthy vaginal cells and restores vaginal balance (by lowering vaginal pH).
oral rather than vaginal
may increase hot flashes
increases the risk of blood clots
other non-hormonal options
You can get more information and purchase vaginal dilators on line at:
another non-hormonal option to enhance vaginal size and elasticity thus decreasing pain during intercourse. Dilators are tools of increasing width to restore the vaginal opening and vaginal depth to comfortably accept sexual penetration. Dilator exercises are typically done once or twice a day in 20- or 30-minute sessions, after a hot bath.
Dilators are hormone-free but the process takes time. It may take three months or longer for your vagina to expand enough for vaginal intercourse. Dilators are typically used with a vaginal lubricant.
The vaginal microbiome (your vaginal environment) is affected by the changes of estrogen experienced in menopause. A healthy vaginal microbiome prevents bad bacteria and other harmful organisms from overgrowing. Without this protection, an imbalance may lead to yeast infection, bacterial vaginosis and urinary tract infections. Estrogen helps deposit glycogen into the vaginal tissue nourishing the healthy bacteria (probiotics).
If you opt for a probiotic supplement, choose one with multiple species of both Lactobacillus and Bifidobacterium. Lactobacillus reuteri and Lactobacillus rhamnosus are 2 species helpful for vaginal balance. Such brands are Fem-Dophilus by Jarrow Formulas, UltraFlora Women’s and LoveBug Yeast is a Beast. These and more are available on Dr. Dunne’s Online Dispensary