“The good news is that effective treatment options, such as nonhormone remedies or different forms of low-dose estrogen applied directly to the vagina, are available”.1

Umbrella
What may the Vaginal and Vulval Treatment Options Umbrella include?

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

  • Vaginal Estrogen/Oestrogen Products
  • Vaginal Inserts
  • Vaginal and Vulval Lubricants/Moisturizers
  • Vaginal and Vulval Treatment Options

Vaginal and Vulval Treatment Options

What are some menopause vaginal and vulval treatment options?

On page one and two in Vaginal Dryness: Treatment Options the North American Menopause Society (NAMS) elaborate on:

Vaginal and Vulval Treatment Options

“The good news is that effective treatment options, such as nonhormone remedies or different forms of low-dose estrogen applied directly to the vagina, are available. These can be combined for optimal symptom relief:

  • Non Hormone Remedies
    • Vaginal Lubricants…
    • Vaginal Moisturizers…
    • Regular Sexual Stimulation…
    • Expanding Your Views of Sexual Pleasure…
    • Vaginal Dilators…
    • Pelvic Floor Exercises…
  • Vaginal Estrogen Therapy
    • An effective and safe treatment…
    • Government-approved low-dose vaginal estrogen products…
    • Standard doses of estrogen therapy…
  • Other Prescription Therapies
    • Ospemifene is an oral tablet taken daily for the treatment of painful intercourse caused by vaginal atrophy…
    • Dehydroepiandrosterone (DHEA) is a hormone-containing insert placed into the vagina nightly for…”.2

Vaginal Moisturizers and Vaginal Lubricants

What vaginal moisturizers and vaginal lubricants are available?

In Vaginal Atrophy: Diagnosis & Treatment – Treatment the (United States) Mayo Clinic elaborate on:

“To treat genitourinary syndrome of menopause, your doctor may first recommend over-the-counter treatment options, including:

  • “Vaginal moisturizers. Try a vaginal moisturizer (K-Y Liquibeads, Replens, Sliquid, others) to restore some moisture to your vaginal area. You may have to apply the moisturizer every few days. The effects of a moisturizer generally last a bit longer than those of a lubricant
  • Water-based lubricants. These lubricants (Astroglide, K-Y Jelly, Sliquid, others) are applied just before sexual activity and can reduce discomfort during intercourse. Choose products that don’t contain glycerin or warming properties because women who are sensitive to these substances may experience irritation. Avoid petroleum jelly or other petroleum-based products for lubrication if you’re also using condoms, because petroleum can break down latex condoms on contact”.3

Vaginal Estrogen

What is vaginal estrogen?

In Topical Estrogens and Non-Hormonal Preparations for Postmenopausal Vulvovaginal Atrophy: An EMAS Clinical Guide the European Menopause and Andropause Society (EMAS) explain:

Vaginal and Vulval Treatment Options

“An individualized approach is required for the management of VVA. Topical low-dose estrogens are effective and also alleviate urinary incontinence and prevent recurrent urinary tract infections. Women should not be denied long-term use of topical estrogens as long as they feel that this treatment is of benefit to them, because the safety data are reassuring.

Non-hormonal preparations (lubricants and moisturizers) should be the first-line treatment for VVA in women taking adjuvant endocrine therapies for cancers considered to be hormone-dependent. They can be used over the long term”.4

On page one in Deciding About Hormone Therapy Use, published July 2022, the NAMS elaborate on:

“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 MenoNoteVaginal Dryness” covers this topic in detail)”.5

In Vaginal Atrophy: Diagnosis & Treatment – Treatment the Mayo Clinic elaborate on:

  • “Topical Estrogen
    • Vaginal Estrogen Cream (Estrace, Premarin)…
    • Vaginal Estrogen Suppositories (Imvexxy)…
    • Vaginal Estrogen Ring (Estring, Femring)…
    • Vaginal Estrogen Tablet (Vagifem)…
  • Ospemifene (Osphena)…
  • Prasterone (Intrarosa)…
  • Systemic Estrogen Therapy…
  • Vaginal Dilators…
  • Topical Lidocaine…
  • If you’ve had breast cancer…”.6

On page three 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, published 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”.7

Other Options

What other options are available?

In Vaginal Atrophy: Diagnosis & Treatment – Treatment the Mayo Clinic elaborate on:

  • “Ospemifene (Osphena)…
  • Prasterone (Intrarosa)…
  • Systemic Estrogen Therapy…
  • Vaginal Dilators…
  • Topical Lidocaine…
  • If you’ve had breast cancer…”.8

Health Care Provider

What if I would like to make down there less bothersome?

If you would like to make down there less bothersome, it may be in your best interest to choose to talk to your health care provider about this.

In Vaginal Discomfort: Discomfort Not Directly Related To Menopause the NAMS note:

“Because vaginal discomfort can arise from so many different sources, persistent symptoms of dryness, irritation, burning, itchiness, or pain should be evaluated by a healthcare provider to determine their cause”.9

In Vaginal Atrophy: Symptoms & Causes – Symptoms: When To See A Doctor the Mayo Clinic encourage us to:

“Make an appointment with your doctor if you have any unexplained vaginal spotting or bleeding, unusual discharge, burning, or soreness.

Also make an appointment to see your doctor if you experience painful intercourse that’s not resolved by using a vaginal moisturizer (K-Y Liquibeads, Replens, Sliquid, others) or water-based lubricant (Astroglide, K-Y Jelly, Sliquid, others)”.10

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Sources

  1. Vaginal Dryness: Treatment Options. 2018:1-2. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 12 September 2022
  2. Vaginal Dryness: Treatment Options. 2018:1-2. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/mn-vaginal-dryness.pdf Accessed: 12 September 2022
  3. Vaginal Atrophy: Diagnosis & Treatment – Treatment. 17 September 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/diagnosis-treatment/drc-20352294 Accessed: 12 September 2022
  4. Topical Estrogens and Non-Hormonal Preparations for Postmenopausal Vulvovaginal Atrophy: An EMAS Clinical Guide. 13 April 2021. European North Menopause and Andropause Society https://www.maturitas.org/article/S0378-5122(21)00061-X/fulltext Accessed: 12 September 2022
  5. 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: 12 September 2022
  6. Vaginal Atrophy: Diagnosis & Treatment – Treatment. 17 September 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/diagnosis-treatment/drc-20352294 Accessed: 12 September 2022
  7. 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 10 June 2022:3-4. https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 12 September 2022
  8. Vaginal Atrophy: Diagnosis & Treatment – Treatment. 17 September 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/diagnosis-treatment/drc-20352294 Accessed: 12 September 2022
  9. Vaginal Discomfort: Discomfort Not Directly Related To Menopause. North American Menopause Society https://www.menopause.org/for-women/sexual-health-menopause-online/causes-of-sexual-problems/vaginal-discomfort Accessed: 12 September 2022
  10. Vaginal Atrophy: Symptoms & Causes – Symptoms: When To See A Doctor. 17 September 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288 Accessed: 12 September 2022
Topic Last Updated: 12 September 2022 – Topic Last Reviewed: 12 September 2022

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