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?

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)”.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 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”.5

Compounded Vaginal Estrogen

Is compounded vaginal estrogen 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”.6

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.

Other Vaginal Symptoms

Can there be other vaginal and vulvar symptoms at this time, not related to menopause?

On page two in Vaginal Dryness the NAMS include:

“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”.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

Health Topics A-Z

Where may I find Health Topics 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. Bioidentical Hormones Explained – A British Menopause Society Video
  4. Bioidentical Hormones: Are They Safer?
  5. Caredownthere
  6. Complementary Medicine Options for Menopausal Symptoms
  7. Complementary and Alternative Therapies Explained – A British Menopause Society Video
  8. Consumer Health: Treating Vaginal Dryness After Menopause
  9. Deciding About Hormone Therapy
  10. Deciding About Hormone Therapy Use
  11. Dr Gail Busby – I Forgot To Ask the Doctor – Episode 9 The Menopause
  12. Early Treatment of Vulvovaginal Atrophy May Prevent Distressing Symptoms
  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. Estradiol Vaginal Cream
  16. Estrogen (Vaginal Route): Before Using
  17. Estrogen (Vaginal Route): Description and Brand Names
  18. Estrogen (Vaginal Route): Precautions
  19. Estrogen (Vaginal Route): Proper Use
  20. Estrogen (Vaginal Route): Side Effects
  21. Estrogen Vaginal
  22. Experiencing Vaginal Dryness? Here’s What You Need To Know
  23. HRT
  24. HRT – Types, Doses and Regimens
  25. HRT: Benefits and Risks
  26. Hormone Replacement Therapy (HRT) Explained – A British Menopause Society Video
  27. Hormone Replacement Therapy (HRT): Alternatives
  28. Hormone Therapy: Is It Right for You?
  29. How Do I Deal With Vaginal Atrophy? — Ask Dr Jean
  30. I Forgot To Ask the Doctor – E9: The Menopause. Can Every Woman That Wants It Have HRT?
  31. International Society for the Study of Women’s Sexual Health: Find A Provider
  32. 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
  33. 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]
  34. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Signs and Symptoms [+ Video: Talking Menopause With Your GP]
  35. 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]
  36. Let’s Talk About Perimenopause
  37. Looking After Yourself: Sex and Relationships
  38. Managing Your Symptoms: Managing Bladder, Vaginal and Vulval Problems
  39. Mayo Clinic Q and A: Treatment for Vaginal Dryness for Menopausal Women
  40. Menopause
  41. Menopause
  42. Menopause
  43. Menopause
  44. Menopause
  45. Menopause
  46. Menopause FAQs: Hormone Therapy for Menopause Symptoms
  47. Menopause FAQs: Menopause Symptoms – Q. How Can I Counteract Vaginal Dryness During Menopause?
  48. Menopause Map: Downloadable Resources – My Personal Path Print Tools – Questions for Your Health Care Provider
  49. Menopause Patient Information [Videos] 2. Talking To Your GP About Menopause
  50. Menopause Patient Information [Videos] 4. The Different Types of HRT
  51. Menopause Preparedness Toolkit Video Series: Common Conditions Associated With Menopause and Midlife
  52. Menopause Preparedness Toolkit: A Woman’s Empowerment Guide
  53. Menopause Ruining Your Sex Life?
  54. Menopause Symptoms: Mayo Clinic Expert Outlines Hormone and Nonhormonal Therapies
  55. Menopause Treatments: What Works, What Doesn’t – Treatments for Vaginal Dryness
  56. Menopause and Sex – Fact Sheet
  57. Menopause: Diagnosis & Treatment
  58. Menopause: Diagnosis and Management – Information for the Public: Questions To Ask About Menopause [NICE Guideline]
  59. National Center for Complementary and Integrative Health: How Safe Is This Product or Practice?
  60. National Center for Complementary and Integrative Health: Menopausal Symptoms: In Depth
  61. Natural Remedies To Help Manage Perimenopause Symptoms
  62. Navigating Menopause Together: How Partners Can Help
  63. Navigating Menopause: Expert Insights and Solutions | Dr Susan Davis | The Proof Podcast EP 245
  64. Oestrogen Only Menopausal Hormone Therapy
  65. Patty Brisben Foundation for Women’s Sexual Health: Guide To Sexual Health Providers
  66. Perimenopause and Menopause Symptom Checklist
    Perimenopause Symptom Checklist
  67. Public Assessment Report – Prescription Only Medicine To Pharmacy Reclassification – Gina 10 Microgram Vaginal Tablets
  68. Risks and Benefits of MHT
  69. Safety of Vaginal Estrogens: A Recap of A Systematic Review [Video]
  70. Supporting A Loved One Through Menopause
  71. The 2020 Genitourinary Syndrome of Menopause Position Statement of The North American Menopause Society
  72. The North American Menopause Society Releases Its 2022 Hormone Therapy Position Statement
  73. Tips To Help Manage Menopause Symptoms
  74. Topical Estrogens and Non-Hormonal Preparations for Postmenopausal Vulvovaginal Atrophy: An EMAS Clinical Guide
  75. Urogenital Atrophy Explained – A British Menopause Society Video
  76. Urogenital Problems
  77. Using Natural Therapies In the Menopause Transition – Webinar
  78. Vaginal Atrophy
  79. Vaginal Dryness
  80. Vaginal Dryness
  81. Vaginal Dryness
  82. 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?
  83. Vaginal Dryness Alternative Treatments
  84. Vaginal Dryness: Treatment Options
  85. Vaginal Estrogen
  86. Video Series-2022: Discussing Sexual Health Concerns With Your Health Care Professional
  87. Video Series-2022: Hormone Therapy: Understanding the Risks and Benefits
  88. Video Series-2022: Perimenopause, Signs, Symptoms, and Solutions
  89. Videos and Podcasts: Videos – Interviews: Menopause and Abnormal Bleeding
  90. Videos and Podcasts: Videos – Interviews: Vulvovaginal Atrophy
  91. Vulva and Vaginal Health: Getting the Right Advice
  92. Vulvovaginal Atrophy
  93. Vulvovaginal Health
  94. Vulvovaginal Symptoms After Menopause
  95. Webinars: Previous – The Early Menopausal Patient
  96. Webinars: Previous – VVA – The Silent Epidemic
  97. What Everyone Should Know About Menopause Symptoms
  98. Why Didn’t Anyone Tell Me This? Episode 3: Dr Annice Mukherjee: Your Essential Menopause Toolkit
  99. Wild Yam
  100. You Need To Know [+ Video: Bleeding After the Menopause – An Important Message You Need To Know]

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: 04 April 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: 04 April 2023
  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: 04 April 2023
  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: 04 April 2023
  5. 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: 04 April 2023
  6. Vaginal Dryness: Note. 2022: 2. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 04 April 2023
  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: 04 April 2023
  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: 04 April 2023
Topic Last Updated: 04 April 2023 – Topic Last Reviewed: 04 April 2023

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