Treatment for Vaginal Itching After Menopause

Vaginal estrogen therapy is the most effective treatment for postmenopausal vaginal itching and associated symptoms of vaginal atrophy. 1

Understanding Vaginal Itching After Menopause

Vaginal itching is a common symptom of vaginal atrophy (also called genitourinary syndrome of menopause), affecting approximately 50% of postmenopausal women due to decreased estrogen levels 1, 2
Associated symptoms include vaginal dryness, burning sensation, discomfort, pain during intercourse (dyspareunia), and vaginal discharge 1, 2
Unlike vasomotor symptoms (hot flashes) which tend to resolve over time, vaginal atrophy symptoms typically persist indefinitely and often worsen without treatment 1

Regular use of over-the-counter vaginal moisturizers for daily maintenance to relieve dryness and discomfort 1, 3
Water-based or silicone-based lubricants during sexual activity (silicone-based products may last longer) 1, 4
Topical products containing hyaluronic acid, vitamin E, and vitamin A can help prevent vaginal mucosal inflammation, dryness, and bleeding 1, 3

Vaginal estrogen therapy is the most effective treatment when non-hormonal options fail to provide adequate relief 1, 5
Available in several forms:
- Vaginal creams (estradiol, conjugated estrogens) 6, 4
- Vaginal tablets 5, 4
- Vaginal rings (sustained-release) 5, 4
Low-dose formulations minimize systemic absorption while effectively treating symptoms 1, 6
A large cohort study of almost 50,000 patients with breast cancer followed for up to 20 years showed no evidence of increased breast cancer-specific mortality in those using vaginal estrogen 5

Vaginal DHEA (prasterone) is FDA-approved for vaginal dryness and pain with sexual activity 1, 5
- Improves sexual desire, arousal, pain, and overall sexual function 1
- Should be used with caution in women receiving aromatase inhibitor therapy 5
Ospemifene, an FDA-approved selective estrogen receptor modulator (SERM), effectively treats vaginal dryness and dyspareunia 5, 1
- Not recommended for women with a history of estrogen-dependent cancers 5
Pelvic floor physical therapy can improve sexual pain, arousal, lubrication, and satisfaction 5, 1
Vaginal dilators may help with pain during sexual activity and increase vaginal accommodation 5, 1
Topical anesthetics may help with vaginal pain 5

For women with a history of hormone-sensitive cancers:
- Begin with non-hormonal options 1
- If vaginal estrogen is needed, discuss risks and benefits with healthcare provider 1
- Estriol-containing preparations may be preferable for women on aromatase inhibitors as estriol is a weaker estrogen 1
Vaginal estradiol may increase circulating estradiol in aromatase inhibitor users, potentially reducing the efficacy of these medications 1
Without treatment, symptoms of vaginal atrophy typically worsen over time 1, 7

Re-evaluate symptoms at regular intervals to assess treatment effectiveness 5
Monitor for adverse effects, particularly if using hormonal treatments 6
For women using vaginal estrogen, be aware of potential side effects including vaginal bleeding, which should be promptly reported to healthcare provider 6