Hormone Therapy and Vaginal Dryness

“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?

DotS the definition of vaginal oestrogen may vary. In Hormone Replacement Therapy (HRT): Vaginal Oestrogen: About Vaginal Oestrogen the NHS definition is:

“Vaginal oestrogen is a hormone replacement therapy (HRT) medicine that contains the hormone oestrogen. It’s used to treat the vaginal dryness and irritation that can happen during the menopause”.3

On page one in Deciding About Hormone Therapy, published 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)”.4

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”.5

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 online 10 June 2022, one of the recommendations is:

  • “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”.6

Compounded Vaginal Estrogen and Testosterone

Are compounded vaginal estrogen and testosterone recommended?

On page two in Vaginal Dryness, published November 2022, the NAMS include:

“Notes: Compounded vaginal estrogen and testosterone are not FDA regulated or recommended for treatment of GSM in most cases”.7

What is FDA?

FDA in this context, is an abbreviation for the (United States) Food and Drug Administration.

What is GSM?

GSM in this context, is an abbreviation for the Genitourinary Syndrome of Menopause.

Health Care Provider

What if my vaginal symptoms do not improve with treatment?

On page two in Vaginal Dryness, published November 2022, the NAMS explain:

“Notes: Vaginal and vulvar symptoms not related to menopause include yeast infections, allergic reactions, and certain skin conditions, so consult your healthcare professional if symptoms do not improve with treatment”.8

Health Topics A-Z

Where may I find Health Topics A-Z related to Hormone Therapy and Vaginal Dryness?

In Health Topics A-Z you may find:

Health Topics A-Z

Links

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Links

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New or Updated

  1. Askearlymenopause.org [Ask EM] [+ Video: What Is Early Menopause?]
  2. BMS & WHC’s 2020 Recommendations on Hormone Replacement Therapy In Menopausal Women
  3. BMS Statement on Testosterone
  4. BMS TV: Bioidentical Hormones
  5. BMS TV: Hormone Replacement Therapy (HRT)
  6. BMS TV: Testosterone Explained
  7. BMS TV: Urogenital Atrophy
  8. Bioidentical Hormones: Are They Safer?
  9. Caredownthere
  10. Consumer Health: Treating Vaginal Dryness After Menopause
  11. Deciding About Hormone Therapy
  12. Deciding About Hormone Therapy Use
  13. Easier Access To Locally Applied HRT To Treat Postmenopausal Vaginal Symptoms In Landmark MHRA Reclassification [British Menopause Society]
  14. Easier Access To Locally-Applied HRT To Treat Postmenopausal Vaginal Symptoms In Landmark MHRA Reclassification [Medicines & Healthcare Products Regulatory Agency, GOV.UK]
  15. Endometrial Safety of Low-Dose Vaginal Estrogens
  16. Endometrial Safety of Low-Dose Vaginal Estrogens [Video]
  17. Estradiol Vaginal Cream
  18. Estrogen (Vaginal Route): Before Using
  19. Estrogen (Vaginal Route): Description and Brand Names
  20. Estrogen (Vaginal Route): Precautions
  21. Estrogen (Vaginal Route): Proper Use
  22. Estrogen (Vaginal Route): Side Effects
  23. Estrogen Vaginal
  24. Experiencing Vaginal Dryness? Here’s What You Need To Know
  25. HRT
  26. HRT – Types, Doses and Regimens
  27. HRT: Benefits and Risks
  28. Hormone Replacement Therapy (HRT)
  29. Hormone Replacement Therapy (HRT): Vaginal Oestrogen
  30. Hormone Replacement Therapy (HRT): Vaginal Oestrogen: About Vaginal Oestrogen
  31. Hormone Replacement Therapy (HRT): Vaginal Oestrogen: Common Questions About Vaginal Oestrogen
  32. Hormone Replacement Therapy (HRT): Vaginal Oestrogen: Side Effects of Vaginal Estrogen
  33. Hormone Therapy: Is It Right for You?
  34. How Do I Deal With Vaginal Atrophy? — Ask Dr Jean
  35. I Forgot To Ask the Doctor – E9: The Menopause. Can Every Woman That Wants It Have HRT?
  36. International Society for the Study of Women’s Sexual Health: Find A Provider
  37. 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
  38. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Sexual Wellbeing and Intimacy During and After Menopause [+ Video: Menopause Is the End of Your Sex Life]
  39. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Signs and Symptoms [+ Video: Talking Menopause With Your GP]
  40. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Supporting Someone Through the Menopause [+ Video: Men Don’t Need To Know About Menopause]
  41. Let’s Talk About Perimenopause
  42. Looking After Yourself: Sex and Relationships
  43. Lubricant Alternatives: What To Use and What To Avoid
  44. Managing Your Symptoms: Managing Bladder, Vaginal and Vulval Problems
  45. Mayo Clinic Q and A: Treatment for Vaginal Dryness for Menopausal Women
  46. Menopause
  47. Menopause
  48. Menopause
  49. Menopause
  50. Menopause Map: Downloadable Resources – My Personal Path Print Tools – Questions for Your Health Care Provider
  51. Menopause Patient Information [Videos] 2. Talking To Your GP About Menopause
  52. Menopause Patient Information [Videos] 4. The Different Types of HRT
  53. Menopause Preparedness Toolkit Video Series: Common Conditions Associated With Menopause and Midlife
  54. Menopause Preparedness Toolkit: A Woman’s Empowerment Guide
  55. Menopause Ruining Your Sex Life?
  56. Menopause Symptoms: Mayo Clinic Expert Outlines Hormone and Nonhormonal Therapies
  57. Menopause Treatments: What Works, What Doesn’t – Treatments for Vaginal Dryness
  58. Menopause: Things You Can Do
  59. Menopause: Understanding the Changes and Finding Relief | Dr Susan Davis | The Proof Podcast EP 256
  60. Mymenoplan.org [My Menoplan, United States]
  61. Navigating Menopause Together: How Partners Can Help
  62. Navigating Menopause: Expert Insights and Solutions | Dr Susan Davis | The Proof Podcast EP 245
  63. Patty Brisben Foundation for Women’s Sexual Health: Guide To Sexual Health Providers
  64. Perimenopause and Menopause Symptom Checklist
    Perimenopause Symptom Checklist
  65. Position Statement for Management of Genitourinary Syndrome of the Menopause (GSM)
  66. Prosayla Supported By ISSWSH [International Society for the Study of Women’s Sexual Health]
  67. Public Assessment Report – Prescription Only Medicine To Pharmacy Reclassification – Gina 10 Microgram Vaginal Tablets
  68. Risks and Benefits of MHT
  69. Supporting A Loved One Through Menopause
  70. The 2020 Genitourinary Syndrome of Menopause Position Statement of The North American Menopause Society
  71. The North American Menopause Society Releases Its 2022 Hormone Therapy Position Statement
  72. The Truth About Menopause Supplements | Dr Sarah Berry
  73. Therapy for the Effects of Menopause
  74. Tips To Help Manage Menopause Symptoms
  75. Topical Estrogens and Non-Hormonal Preparations for Postmenopausal Vulvovaginal Atrophy: An EMAS Clinical Guide
  76. Urogenital Problems
  77. Urologic View In the Management of Genitourinary Syndrome of Menopause
  78. Using Natural Therapies In the Menopause Transition – Webinar
  79. Vaginal Atrophy
  80. Vaginal Dryness
  81. Vaginal Dryness
  82. Vaginal Dryness
  83. 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?
  84. Vaginal Dryness Alternative Treatments
  85. Vaginal Dryness: Treatment Options
  86. Vaginal Dryness: What To Do About It
  87. Vaginal Oestrogen
  88. Vaginal Laser Therapy for GSM/VVA: Where We Stand Now – A Review By the EUGA Working Group on Laser
  89. Video Series-2022: Discussing Sexual Health Concerns With Your Health Care Professional
  90. Video Series-2022: Hormone Therapy: Understanding the Risks and Benefits
  91. Video Series-2022: Perimenopause, Signs, Symptoms, and Solutions
  92. Video Series-2023: NAMS 2023 Nonhormone Therapies Position Statement for Bothersome Menopause Symptoms
  93. Videos and Podcasts: Videos – Interviews: A Simple Approach To Menopause: The Menopause Quick Six (www.MQ6.ca)
  94. Videos and Podcasts: Videos – Interviews: Vulvovaginal Atrophy
  95. Vulva and Vaginal Health: Getting the Right Advice
  96. Vulvovaginal Atrophy
  97. Vulvovaginal Health
  98. Webinars: Previous – Pay Attention on Your Way In! The Vulva Is An Important Organ Too
  99. Why Didn’t Anyone Tell Me This? Episode 3: Dr Annice Mukherjee: Your Essential Menopause Toolkit
  100. Wild Yam

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: 19 November 2023
  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? 07 December 2022. Mayo Clinic https://www.mayoclinic.org/vaginal-dryness-after-menopause/expert-answers/faq-20115086 Accessed: 19 November 2023
  3. Hormone Replacement Therapy (HRT): Vaginal Oestrogen: About Vaginal Oestrogen. Page Last Reviewed: 27 January 2023. NHS https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/vaginal-oestrogen/about-vaginal-oestrogen/ Accessed: 19 November 2023
  4. 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: 19 November 2023
  5. Vulvovaginal Atrophy: Topical Vaginal Estrogens. 2022. European Menopause and Andropause Society https://emas-online.org/wp-content/uploads/2022/07/Vulvovaginal-atrophy.pdf Accessed: 19 November 2023
  6. Hamoda, H., Mukherjee, A., Morris, E., Baldeweg, S. E., Jayasena, C. N., Briggs, P., Moger, S. 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 Online 10 June 2022:3-4. https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 19 November 2023
  7. Vaginal Dryness: Note. 2022: 2. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 19 November 2023
  8. Vaginal Dryness: Note. 2022: 2. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 19 November 2023
Topic Last Updated: 19 November 2023 – Topic Last Reviewed: 19 November 2023

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