- Moisturizers. Like lubricants, vaginal moisturizers reduce the painful friction that sex can cause as a result of vaginal atrophy. Additionally, moisturizers, unlike lubricants, are absorbed into the skin and cling to the vaginal lining in a way that mimics natural secretions. Another difference is that moisturizers are applied regularly, not just before sex, and their effects are more long-term, lasting up to 3 or 4 days. Some moisturizers have an applicator to help place the product into the vagina.
- Low-dose vaginal estrogen therapy. Estrogen products designed for vaginal application have been proven to restore vaginal blood flow and improve the thickness and stretchiness of vaginal tissue in peri- and postmenopausal women. These products act to reverse the thinning and dryness of vaginal tissues rather than just providing the temporary relief that lubricants and moisturizers do. For this reason, low-dose vaginal estrogen is appropriate in most cases for peri- and postmenopausal women who do not get sufficient relief from moisturizers or lubricants or whose symptoms of vaginal atrophy are interfering with their quality of life.
Vaginal estrogen should be used at the lowest effective dose, again to limit any effects elsewhere in the body. If you’ve had breast cancer, be sure to mention this to your healthcare provider before using estrogen in any form so that you can properly weigh its benefits and risks.
Low-dose vaginal estrogen is very effective against atrophy-related pain during sex, with up to 93% of women reporting significant improvement and 57% to 75% reporting that their sexual comfort is restored. Improvements in vaginal moisture and health typically occur within a few weeks of starting therapy, although relief from severe vaginal atrophy can take several months.
All forms of vaginal estrogen are similarly effective, and most forms are associated with minimal side effects, although women’s individual responses may differ. The form chosen should be based on your individual preference, factoring in cost and insurance coverage, after discussion with your healthcare provider.
If low-dose vaginal estrogen therapy is right for you, you may also use lubricants and moisturizers as needed. Sometimes, after estrogen therapy has restored the vaginal tissues to a more healthy state, it can be stopped and nonhormonal lubricants or moisturizers can be used alone. To maintain the benefit, however, it is important to continue regular vaginal sexual activity.
Visit the NAMS Sexual Health and Menopause online module for more!