“If you are bothered only by vaginal dryness,
you can use very low doses of estrogen
placed directly into the vagina”.1

Umbrella
What may the Hormone Therapy and Vaginal Dryness Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • Atrophic Vaginitis
  • Genital Atrophy
  • Genitourinary Syndrome of Menopause
  • Hormone Replacement Therapy (HRT)
  • Hormone Therapy (HT)
  • Local Low-Dose Estrogen Therapy
  • Menopausal Hormone Therapy (MHT)
  • Vaginal Atrophy
  • Vaginal Dryness
  • Vaginal Estrogen/Oestrogen
  • Vaginal Symptoms
  • Vulvovaginal Atrophy

Vaginal Dryness

What is vaginal dryness?

DotS the definition of vaginal dryness may vary. In Vaginal Dryness After Menopause: How To Treat It? I’m postmenopausal and often have vaginal dryness, which makes intercourse painful. Is there anything I can do about it? the (United States) Mayo Clinic’s definition is:

“Vaginal dryness can be a problem for many postmenopausal women. Vaginal dryness is a hallmark sign of the genitourinary syndrome of menopause, also known as atrophic vaginitis or vaginal atrophy. With this condition, vaginal tissues become thinner and more easily irritated — resulting from the natural decline in your body’s estrogen levels during menopause”.2

Vaginal Estrogen

What is vaginal estrogen?

On page one in Deciding About Hormone Therapy, published in July 2022, the North American Menopause Society (NAMS) explain:

“If you are bothered only by vaginal dryness, you can use very low doses of estrogen placed directly into the vagina. These low doses generally do not raise blood estrogen levels above postmenopause levels and do not treat hot flashes. You do not need to take a progestogen when using only low doses of estrogen in the vagina. (The MenoNote “Vaginal Dryness” covers this topic in detail)”.3

Cream, Tablet, Pessary or Ring

How can estrogen be applied directly to the vagina?

In Vulvovaginal Atrophy: Topical Vaginal Estrogens the European Menopause and Andropause Society explain:

Hormone Therapy and Vaginal Estrogen

  • “These may contain estradiol, estriol, promestriene and conjugated estrogens
  • Preparations include tablets, rings, capsules, creams, gels and ovules
  • Most are low-dose and do not change systemic estrogen levels
  • There is no need to add progestogen (for endometrial protection) when low-dose topical estrogens are used
  • They can be used alone or with systemic menopausal hormone therapy
  • They may also improve urinary incontinence and prevent recurrent urinary tract infections
  • They do not increase the risk of endometrial cancer, breast cancer, venous thromboembolism or cardiovascular disease”.4

Duration

How long can vaginal estrogen be used for?

On page three and four in the Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause, first published 10 June 2022, Hamoda et al. note:

  • “Low-dose and ultra-low dose vaginal oestrogen preparations can be taken by perimenopausal and menopausal women experiencing genitourinary symptoms and continued for as long as required. All vaginal oestrogen preparations have been shown to be effective in this context and there is no requirement to combine vaginal oestrogens with systemic progestogen treatment for endometrial protection, as low-dose and ultra-low dose vaginal oestrogen preparations do not result in significant systemic absorption or endometrial hyperplasia”.5

Vaginal Symptoms

Are all vaginal symptoms at this time, related to menopause?

On page two in Vaginal Dryness the NAMS explain:

“Note: Vaginal symptoms not related to menopause include yeast infections, allergic reactions, and certain skin conditions, so consult your healthcare provider if symptoms do not improve with treatment”.6

Health Care Provider

What if I think I have vaginal dryness?

If you think you have vaginal dryness, it may be in your best interest to choose to talk to your health care provider about this.

In Vulvovaginal Symptoms After Menopause the Australasian Menopause Society caution:

  • “Unlike some menopausal symptoms, such as hot flushes, which may disappear as time passes; genito-urinary problems often persist and may progress with time. Genito-urinary symptoms are associated both with menopause and with ageing”.7

The NAMS also note:

“You should discuss your individual risks and preferences with your healthcare team to determine whether hormone therapy or alternatives, including FDA-approved nonhormonal therapies, are right for you”.8

What is FDA?

FDA can be an abbreviation for the (United States) Food and Drug Administration.

Health Topics A-Z

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Links

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Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

Sources

  1. Deciding About Hormone Therapy Use. 2022:1 North American Menopause Society https://www.menopause.org/docs/default-source/professional/menonote-deciding-about-ht-2022.pdf Accessed: 03 November 2022
  2. Vaginal Dryness After Menopause: How To Treat It? I’m postmenopausal and often have vaginal dryness, which makes intercourse painful. Is there anything I can do about it? 18 June 2022. Mayo Clinic https://www.mayoclinic.org/vaginal-dryness-after-menopause/expert-answers/faq-20115086 Accessed: 03 November 2022
  3. Deciding About Hormone Therapy Use. 2022:1 North American Menopause Society https://www.menopause.org/docs/default-source/professional/menonote-deciding-about-ht-2022.pdf Accessed: 03 November 2022
  4. Vulvovaginal Atrophy: Topical Vaginal Estrogens. 2022. European Menopause and Andropause Society https://emas-online.org/wp-content/uploads/2022/07/Vulvovaginal-atrophy.pdf Accessed: 03 November 2022
  5. Hamoda et al. Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause. Fist published 10 June 2022:3-4. https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 03 November 2022
  6. Vaginal Dryness: Note. 2018: 2. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 03 November 2022
  7. Vulvovaginal Symptoms After Menopause. Content Created September 2018. Australasian Menopause Society https://www.menopause.org.au/hp/information-sheets/376-vulvovaginal-symptoms-after-menopause Accessed: 03 November 2022
  8. Menopause FAQs: Hormone Therapy for Menopause Symptoms – Q. What Is Hormone Therapy? North American Menopause Society https://www.menopause.org/for-women/menopause-faqs-hormone-therapy-for-menopause-symptoms Accessed: 03 November 2022
Topic Last Updated: 03 November 2022 – Topic Last Reviewed: 03 November 2022

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