“There are many effective treatment options for GSM, including over-the-counter and prescription therapies. First-line therapies for less severe symptoms include nonhormone over-the-counter lubricants used as needed for sexual activity and moisturizers used regularly (several times per week) to maintain moisture. Prescription therapies include low-dose vaginal estrogens, vaginal dehydroepiandrosterone inserts, and oral ospemifene. Nonhormone lubricants and moisturizers can be combined for optimal symptom relief and can be used in combination with prescription therapies for more severe symptoms.

• Nonhormone Remedies
  • Vaginal Lubricants…
  • Vaginal Moisturizers…
  • Regular Sexual Stimulation…
  • Expanding Your Views of Sexual Pleasure…
  • Vaginal Dilators…
  • Pelvic Floor Exercises…
• Vaginal Hormone Therapy…
  • An effective and safe treatment, low-dose local estrogen applied directly to the vagina relieves vaginal dryness and discomfort with sexual activity. Improvements usually occur within a few weeks or months with consistent use.
  • FDA-approved low-dose vaginal estrogen products…
  • Dehydroepiandrosterone (DHEA; Prasterone)
  • Low-dose vaginal estrogen or DHEA may be options for…
• Systemic Estrogen Therapy
• Other Therapies…
  • Ospemifene
  • Vaginal Laser Therapy…”.²

“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

“Lubricants and moisturizers are available without a prescription and can be purchased at drug or grocery stores. They work by replenishing your vaginal tissue and making it wet, which can help with pain during sex. You shouldn’t use moisturizers (such as for your face or body) that aren’t meant for your vagina.

• Vaginal moisturizers: Apply vaginal moisturizers to the inside of your vagina every few days to keep your vaginal lining healthy. Some examples include Replens™, Luvena® and KY® Liquibeads.
• Vaginal lubricants: Apply lubricants just before sexual intercourse to ease discomfort caused by sex. Astroglide® and KY® Jelly are examples of water-based vaginal lubricants. There are also silicone-based and oil-based lubricants”.⁴

“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”.⁵

• “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…”.⁷

• “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”.⁸

• “Ospemifene (Osphena)…
• Prasterone (Intrarosa)…
• Systemic Estrogen Therapy…
• Vaginal Dilators…
• Topical Lidocaine…
• If you’ve had breast cancer…”.⁹

“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)”.¹¹