By Jeanne Novas, MD 

In menopause, patients often experience vaginal dryness with intercourse, pain with intercourse, urinary urgency, incontinence and vaginitis due to the vaginal dryness and atrophy caused by lack of estrogen. Sex drive can be lowered just because of the pain that can occur with vaginal dryness in intercourse.

Many of us need to treat vaginal dryness in order to prevent urinary symptoms, vaginitis and to continue having a satisfying sex life.

Many over-the-counter treatments can at least give lubrication:

• Coconut oil
• Replens®
• Neo-gyn® cream — also may help repair tissue

More effective prescription medications given vaginally add estrogen directly to the vagina without being absorbed throughout your body, with the only side effect of increased vaginal discharge. There is no risk of cancer or systemic side effects. The FDA still labels these medications with “risks”, and various organizations are trying to have these warnings removed after extensive research has demonstrated their safety. Patients who have breast cancer may not be able to use these products. Here are the products available:

• Estrace® cream, Premarin® cream, or a compounded cream that is less expensive.
• Vagifem® – a vaginal tablet, generic available
• Estring® – a vaginal ring that releases estrogen for 3 months.

There is an oral medication that will treat menopausal vaginal dryness called Osphena®. It does work well, but can cause hot flashes and increase the risk of blood clots in some patients. It can be used by breast cancer patients in some cases. It is costly, depending on insurance.

Lastly, there are laser treatments to improve vaginal health. They are fairly safe and not painful, but are costly and so far there are no studies that compare them to existing treatments. They may have an indication in breast cancer patients.

Be sure to discuss treatments with your doctor, and see what is right for you. Always have a gyne exam by your gynecologist if you are having symptoms of vaginal dryness, in case of other medical issues.

-Jeanne Novas MD