Menopause-related vaginal dryness often leads to pain with penetration and during deep intercourse, and can be associated with arousal difficulties as well.
Many different topical vaginal treatments are available,
One of the best options to treat the atrophy is with Low-dose vaginal estrogen therapy.
Estrogen products designed for vaginal application have been proven to restore vaginal blood flow and improve the thickness and stretchiness of vaginal tissue in peri- and postmenopausal women. These products act to reverse the thinning and dryness of vaginal tissues rather than just providing the temporary relief that lubricants and moisturizers do.
For this reason, low-dose vaginal estrogen is appropriate in most cases for peri- and postmenopausal women who do not get sufficient relief
from moisturizers or lubricants or whose symptoms of vaginal atrophy are interfering with their quality of life.
Adding testosterone to vaginal estriol add extra relief of the symptoms and help with the sexual dysfunction secondary to painful intercourse.
There are different choices in the market. Some doctors choose synthetic hormones and others natural hormones.
Vaginal creams are applied in small amounts (0.5-1.0 g) in the vagina 2 to 3 times a week.
These products, known by the brand names Premarin, Estrace, and (in Canada) Neo-Estrone, should not be used as a lubricant before intercourse since the estrogen can be absorbed through a partner’s skin.
Estring vaginal ring is inserted into the vagina and worn for 3 months before being taken out and replaced; it does not need to be removed
This low-dose estrogen ring is designed only to treat vaginal dryness and should not be confused with Femring, which is another vaginal ring that releases higher doses of estrogen for treating hot flashes and other symptoms of menopause.
Vagifem, the vaginal tablet is placed in the vagina twice a week using an applicator (recommended) or a finger.
Many women find the estrogen tablet less messy than estrogen creams.
When topical estrogens are not sufficient, we also consider treatment with creams and patches of bio-identical hormones.