From the Guidelines
Non-estrogen vaginal creams for vaginal dryness, such as Intrarosa (prasterone) and Osphena (ospemifene), are recommended as effective options for treating vaginal dryness without the use of estrogen. These prescription medications work by stimulating the body's natural lubrication processes without systemic estrogen effects, making them suitable for women who cannot use estrogen products due to breast cancer history, blood clot risks, or other contraindications 1.
Non-Estrogen Vaginal Creams
Some over-the-counter options like Replens, K-Y Jelly, and Astroglide can be applied daily or as needed to provide moisture and lubrication. For immediate relief during intercourse, water-based lubricants like Sliquid or Good Clean Love are recommended.
Prescription Options
- Intrarosa (prasterone) is inserted nightly for the first four weeks, then 3-4 times weekly thereafter.
- Osphena (ospemifene) is an oral tablet taken daily that acts as a selective estrogen receptor modulator specifically for vaginal tissue.
Importance of Regular Application
Regular application is important for maintaining comfort, and you may need to try several products to find what works best for your symptoms. According to the American Cancer Society/American Society of Clinical Oncology breast cancer survivorship care guideline, nonhormonal, water-based lubricants and moisturizers remain the primary treatment for vaginal dryness 1.
Considerations for Breast Cancer Survivors
For breast cancer survivors, it is essential to consider the safety of vaginal hormones, as the evidence is limited, and the panel notes that DHEA should be used with caution in survivors receiving AI therapy 1. The 5th ESO-ESMO International Consensus Guidelines for Advanced Breast Cancer recommend hormone-free lubricants and moisturizers as the first choice for treating vaginal dryness and soreness 1.
Additional Recommendations
The NCCN Guidelines recommend considering ospemifene as an option for dyspareunia in survivors without a history of estrogen-dependent cancers 1. The American Cancer Society/American Society of Clinical Oncology breast cancer survivorship care guideline recommends referral for interventions, such as brief psychoeducational support, group therapy, sexual counseling, marital counseling, or intensive psychotherapy, to address sexual complaints 1.
From the Research
Non-Estrogen Vaginal Creams for Vaginal Dryness
- Vaginal dryness is a common symptom of vulvovaginal atrophy (VVA), which can be distressing for women and cause pain, discomfort, and dyspareunia 2.
- Estrogen replacement can resolve symptoms, but may be contraindicated or not desired by all women, making non-estrogen vaginal creams a viable alternative 2, 3.
Hyaluronic Acid Vaginal Gel
- Hyaluronic acid vaginal gel has been shown to be effective in improving vaginal dryness, with improvement rates of 84.44% after 10 applications, similar to estriol cream 3, 4.
- Hyaluronic acid has moisturizing properties and can provide relief from vaginal dryness, making it a promising alternative to estrogen-based treatments 5.
- Studies have demonstrated that hyaluronic acid vaginal gel is not inferior to estriol vaginal cream in women presenting with vaginal dryness, with similar improvement rates in vaginal itching, burning, and dyspareunia 4.
Other Non-Estrogen Vaginal Creams
- Polycarbophil vaginal moisturizing gel has been shown to be non-inferior to hyaluronic acid gel in treating vaginal dryness, with similar improvements in vaginal health index, vaginal maturation index, and female sexual function index 6.
- Over-the-counter vaginal moisturizers and lubricants can also ease the symptoms of VVA, but their chemical composition varies enormously, and some may cause detrimental effects due to unphysiological pH, osmolality, and additives 2.
Safety and Efficacy
- Studies have demonstrated that non-estrogen vaginal creams, such as hyaluronic acid vaginal gel and polycarbophil vaginal moisturizing gel, are safe and effective in treating vaginal dryness, with minimal adverse events reported 3, 4, 6.
- Women should be directed towards products that are as 'body-similar' as possible to vaginal secretions in terms of pH and osmolality, and products with potentially harmful ingredients should be avoided 2.