What are alternative treatments for vaginal dryness besides Estrace (estradiol) cream?

From the Guidelines

Alternative treatments for vaginal dryness besides Estrace cream include over-the-counter vaginal moisturizers like Replens or K-Y Liquibeads, which can be used 2-3 times weekly to provide ongoing relief, as recommended by the NCCN guidelines 1. These moisturizers can help to improve vaginal tissue quality and reduce symptoms of dryness.

• Water-based lubricants such as K-Y Jelly, Astroglide, or Sliquid can be applied during sexual activity to reduce friction and discomfort.
• For those seeking hormonal options, other prescription estrogen products include Vagifem tablets, Estring (a vaginal ring worn for 90 days), and Imvexxy (low-dose estradiol inserts) 1.
• Non-estrogen prescription medications include Osphena (ospemifene) and Intrarosa (prasterone), which can help thicken vaginal tissue and increase lubrication.
• For women who prefer non-pharmacological approaches, regular sexual activity can improve blood flow to vaginal tissues, and avoiding irritants like scented soaps or douches may help prevent further dryness. Vaginal dryness often occurs due to decreased estrogen levels during menopause, breastfeeding, or certain medications, which leads to thinning of vaginal tissues and reduced natural lubrication.
• Treatment choice depends on the severity of symptoms, personal preferences, and whether there are any contraindications to hormonal therapy, with the American Cancer Society and American Society of Clinical Oncology recommending assessment for signs and symptoms of sexual dysfunction or problems with sexual intimacy 1. The most recent guidelines from the NCCN recommend a stepwise approach to managing vaginal dryness, starting with lubricants and moisturizers, and progressing to hormonal or non-hormonal prescription medications as needed 1.

From the FDA Drug Label

1.2 The Treatment of Moderate to Severe Vaginal Dryness, a Symptom of Vulvar and Vaginal Atrophy, Due to Menopause. 2.2 Treatment of Moderate to Severe Vaginal Dryness, a Symptom of Vulvar and Vaginal Atrophy, Due to Menopause Take one 60 mg tablet with food once daily.

Alternative treatment options for vaginal dryness besides Estrace (estradiol) cream include:

• Ospemifene (OSPHENA): a oral tablet taken once daily with food, specifically indicated for the treatment of moderate to severe vaginal dryness due to menopause 2.

Key considerations:

• Ospemifene is an estrogen agonist/antagonist with tissue selective effects, and its use should be for the shortest duration consistent with treatment goals and risks for the individual woman.
• Postmenopausal women should be re-evaluated periodically to determine if treatment is still necessary.

From the Research

Alternative Treatments for Vaginal Dryness

Besides Estrace (estradiol) cream, there are several alternative treatments for vaginal dryness, including:

• Ospemifene, a nonhormonal oral treatment with an agonist effect on the vaginal epithelium, which has been shown to be effective in treating vaginal dryness and dyspareunia 3, 4, 5, 6
• Vaginal moisturizers and lubricants, which can help to ease the symptoms of vaginal dryness, although their chemical composition varies and some may cause detrimental effects 7
• Hormonal therapy, which can help to resolve symptoms of vaginal dryness, but may be contraindicated or not desired by all women 3, 7

Key Characteristics of Alternative Treatments

Some key characteristics of these alternative treatments include:

• Ospemifene: a selective estrogen receptor modulator (SERM) that has been shown to be effective in treating vaginal dryness and dyspareunia, with a good safety profile 3, 4, 5, 6
• Vaginal moisturizers and lubricants: can be used to ease the symptoms of vaginal dryness, but women should be directed towards products that are as 'body-similar' as possible to vaginal secretions in terms of pH and osmolality 7
• Hormonal therapy: can help to resolve symptoms of vaginal dryness, but may be contraindicated or not desired by all women, and may have potential systemic absorption 3, 7

Efficacy and Safety of Alternative Treatments

The efficacy and safety of these alternative treatments have been studied in several clinical trials, including:

• Ospemifene: has been shown to be effective in treating vaginal dryness and dyspareunia, with significant improvements in vaginal cell populations, vaginal pH, and symptoms of vaginal dryness 3, 4, 5, 6
• Vaginal moisturizers and lubricants: can help to ease the symptoms of vaginal dryness, but their efficacy and safety vary depending on their chemical composition 7
• Hormonal therapy: can help to resolve symptoms of vaginal dryness, but may have potential systemic absorption and other safety concerns 3, 7