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Vaginal Dryness and Vaginal Atrophy (cont.)

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What treatments are available for vaginal dryness and vaginal atrophy?

Vaginal dryness and atrophy do not need to be treated unless they cause symptoms or discomfort. Women who experience symptoms have several treatment options.

Hormone therapy

Hormone therapy (HT) is effective in treating vaginal dryness/vaginal atrophy. HT has also been referred to as hormone replacement therapy (HRT) or postmenopausal hormone therapy (PHT). HT has been shown to effectively reduce vaginal dryness as well as help control hot flashes associated with menopause.

However, HT is not without its risks. Long-term studies (the NIH-sponsored Women's Health Initiative, or WHI) of women who took oral combined hormone therapy containing both estrogen and progesterone showed that these women had an increased risk for heart attack, stroke, and breast cancer when compared with women who did not receive it.

Women taking oral estrogen alone had an increased risk for stroke, but not for heart attack or breast cancer. Estrogen therapy alone, however, is associated with an increased risk of developing endometrial cancer (cancer of the lining of the uterus) in postmenopausal women who have not had their uterus surgically removed.

HT may be administered in pill form or transdermally (patches or sprays from which the medication is absorbed through the skin). Transdermal estogens enter the circulation directly, where oral estrogen products must first pass through the liver from the stomach. Since transdermal hormone products do not have effects on the liver, this route of administration has become the preferred form for most women. A number of preparations are available for oral and transdermal forms of HT, varying in the both type and amount of hormones in the products.

So-called "bioidentical" hormone therapy for perimenopausal women has been a source of much attention in recent years. Bioidentical hormone preparations are hormones with the same chemical formula as those made naturally in the body but which are produced in a laboratory by altering compounds derived from naturally-occurring plant products. While some of these preparations are U.S. FDA-approved and manufactured by drug companies, others are made at special pharmacies called compounding pharmacies, which make the preparations on a case-by-case basis for each patient. Since individually compounded products cannot be standardized, these individual preparations are not regulated by the FDA. There is no evidence that bioidentical preparations provide superior symptom relief. Studies to establish the long-term safety and effectiveness of these products have not yet been carried out.

No matter what form of therapy is used, the decision about hormone therapy should take into account the inherent risks and benefits of the treatment along with each woman's own medical history and the severity of her symptoms. Current recommendations state that if hormone therapy is used, it should be used at the smallest effective dose for the shortest possible time.

Vaginal treatments

There are also local, topical (meaning applied directly to the vagina) low-dose hormonal treatments for the symptoms of vaginal dryness and vaginal atrophy. Local treatments include the vaginal estrogen ring, vaginal estrogen cream, or vaginal estrogen tablets. Local (vaginal) estrogen treatments can be very effective in reducing vaginal dryness while having a minimal effect on other tissues in the body.

There is also now a product for vaginal dryness that consists of a daily pill which contains a selective estrogen receptor modulator (SERM). These are theoretically safer than estrogens and can be alternative for some patients.

Vaginal moisturizing agents such as creams or lotions (for example, K-Y Silk-E Vaginal Moisturizer or KY Liquibeads Vaginal Moisturizer) as well as the use of lubricants during sexual intercourse are non-hormonal options for managing the discomfort of vaginal dryness. A longer acting moisturizer called Replens is also available over the counter.

Applying Betadine topically on the outer vaginal area, and soaking in a sitz bath or soaking in a bathtub of warm water may be helpful for relieving symptoms of burning and vaginal pain after intercourse.

Medically Reviewed by a Doctor on 9/9/2016


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