What are the best treatments for vaginal dryness and atrophy in postmenopause?

From the Guidelines

Vaginal estrogen therapy is the most effective treatment for vaginal dryness and atrophy in postmenopausal women, as it has been shown to be effective in treating itching, discomfort, and painful intercourse. According to the NCCN guidelines 1, low-dose vaginal estrogen therapy is the preferred treatment option. Specific medications include estradiol vaginal cream, estradiol vaginal tablets, or the estradiol vaginal ring, which provide localized relief with minimal systemic absorption 1.

Treatment Options

• Low-dose vaginal estrogen therapy: estradiol vaginal cream (0.5-1g applied daily for 1-2 weeks, then 1-3 times weekly), estradiol vaginal tablets (10mcg inserted twice weekly), or the estradiol vaginal ring (replaced every 90 days) 1
• Non-hormonal options: regular use of vaginal moisturizers like Replens (applied every 2-3 days) and water-based lubricants during sexual activity
• Alternatives for women who cannot use estrogen: ospemifene (Osphena, 60mg daily oral tablet) or prasterone/DHEA (Intrarosa, 6.5mg vaginal insert nightly) 1

Important Considerations

• Women with a history of breast cancer, blood clots, or certain liver conditions should discuss risks with their healthcare provider before using hormonal options 1
• Treatment is typically long-term as symptoms often return when therapy is discontinued
• Most women notice improvement within 2-4 weeks, but consistent use is necessary for ongoing relief 1

Additional Therapies

• Pelvic physical therapy (ie, pelvic floor muscle training) may be beneficial in treating associated pelvic floor dysfunction and improving sexual function 1
• Vaginal dilators may be useful for increasing vaginal depth and accommodation, and allowing women to discover what hurts and what does not in a nonsexual setting 1

From the FDA Drug Label

1.1 The Treatment of Moderate to Severe Dyspareunia, a Symptom of Vulvar and Vaginal Atrophy, Due to Menopause. 1.2 The Treatment of Moderate to Severe Vaginal Dryness, a Symptom of Vulvar and Vaginal Atrophy, Due to Menopause. 2.1 Treatment of Moderate to Severe Dyspareunia, a Symptom of Vulvar and Vaginal Atrophy, Due to Menopause Take one 60 mg tablet with food once daily. 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.

The best treatment for vaginal dryness and atrophy in postmenopause, according to the label, is Ospemifene (60 mg) taken once daily with food. This treatment is indicated for moderate to severe dyspareunia and moderate to severe vaginal dryness, which are symptoms of vulvar and vaginal atrophy due to menopause. 2

From the Research

Treatments for Vaginal Dryness and Atrophy in Postmenopause

• Local vaginal estrogen therapy is a recommended treatment for vaginal atrophy in postmenopausal women, as it is effective and well-tolerated 3, 4, 5.
• Various forms of vaginal estrogen preparations, such as creams, tablets, and rings, are available and have been shown to be effective in relieving symptoms of vaginal atrophy 3, 4.
• Low-dose vaginal estrogen delivery is effective and well-tolerated for treating vaginal atrophy, and all approved products in the United States are equally effective at recommended doses 5.
• Non-hormonal treatments, such as lubricants and moisturizers, can also be used to help manage vaginal dryness and atrophy 4, 6, 7.
• Vaginal suppositories containing hyaluronic acid, vitamin E, and vitamin A have been shown to be safe and effective in treating vaginal atrophy symptoms in postmenopausal women 6.

Safety and Efficacy of Treatments

• Local vaginal estrogen therapy is considered safe and effective for treating vaginal atrophy, with few contraindications 5, 7.
• The use of low-dose vaginal estrogens has been shown to be effective in treating symptoms of vaginal atrophy without causing significant proliferation of the endometrial lining 4, 5.
• There is no evidence of a difference in efficacy between the various intravaginal oestrogenic preparations when compared with each other 3.
• Vaginal estrogen therapy should be continued for women as long as distressful symptoms remain, and progestogen is generally not indicated when low-dose estrogen is administered locally for vaginal atrophy 5.