From the Guidelines
Vaginal estrogen is the most effective treatment for postmenopausal vaginal dryness, as it has been shown to be effective in treating itching, discomfort, and painful intercourse in postmenopausal individuals 1.
Treatment Options
Treatment options for postmenopausal vaginal dryness include both hormonal and non-hormonal approaches.
- For immediate relief, over-the-counter vaginal moisturizers like Replens or K-Y Liquibeads can be applied every 2-3 days, while water-based lubricants such as K-Y Jelly or Astroglide should be used during sexual activity.
- Hormonal treatments include low-dose vaginal estrogen preparations such as estradiol vaginal cream (0.01%, applied 0.5-1g daily for 1-2 weeks, then 1-3 times weekly), estradiol vaginal tablets (10 mcg inserted twice weekly), or the estradiol vaginal ring (released over 90 days) 1.
Non-Hormonal Options
For women who cannot use estrogen, ospemifene (60mg daily oral tablet) is a selective estrogen receptor modulator approved for vaginal dryness, although its use is contraindicated in survivors with a history of estrogen-dependent cancers 1.
- DHEA vaginal suppositories (prasterone 6.5mg daily) can also help by converting to estrogen in vaginal tissues, but their safety in survivors of hormonally mediated cancers is limited 1.
Lifestyle Modifications
Lifestyle modifications like regular sexual activity and avoiding irritants (scented products, douches) can complement these treatments.
- Vaginal dryness occurs because declining estrogen levels after menopause lead to thinning of vaginal tissues, decreased lubrication, and changes in vaginal pH, making treatment important for both comfort and urinary health 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.
Treatment for postmenopausal vaginal dryness is ospemifene (PO), with a dosage of one 60 mg tablet with food once daily 2.
- Indication: Moderate to severe vaginal dryness, a symptom of vulvar and vaginal atrophy, due to menopause.
- Dosage: 60 mg tablet once daily with food.
From the Research
Treatment Options for Postmenopausal Vaginal Dryness
- Local estrogen therapy, such as estradiol vaginal cream, has been shown to be effective in reducing vaginal dryness severity and improving vaginal health 3
- Non-hormonal vaginal creams, such as those containing hamamelis virginiana distillate, have also been found to be effective in improving vaginal moisture and reducing dryness 4
- Selective estrogen receptor modulators (SERMs), such as ospemifene, have been approved for the treatment of dyspareunia, a symptom of vaginal dryness, and have been shown to be effective in improving vaginal health and reducing dryness 5, 6, 7
Hormonal and Non-Hormonal Therapies
- Estradiol vaginal cream (0.003%) has been shown to be effective in reducing vaginal dryness severity and improving vaginal health, with significant improvements in vaginal pH and maturation index 3
- Ospemifene, a non-estrogen SERM, has been shown to be effective in improving vaginal health and reducing dryness, with significant improvements in vaginal pH, maturation index, and severity of vaginal dryness 5, 7
- Non-hormonal vaginal creams, such as those containing hamamelis virginiana distillate, have been found to be effective in improving vaginal moisture and reducing dryness, with significant improvements in local physical function and subjective assessment of vaginal dryness 4
Safety and Efficacy
- Estradiol vaginal cream (0.003%) has been shown to be well-tolerated, with comparable rates of treatment-emergent adverse events to placebo 3
- Ospemifene has been shown to be generally well-tolerated, with beneficial effects on the vagina, neutral effects on the breast, and minimal effects on the endometrium 6, 7
- Non-hormonal vaginal creams, such as those containing hamamelis virginiana distillate, have been found to be well-tolerated, with no serious adverse events reported 4