Treatments for vaginal dryness — natural estrogen products and more

Estriol vaginal cream

Contents

Women to Women’s Healthcare Clinic patients are generally prescribed estriol vaginal cream in a pH-balanced base in concentrations of 0.6 mg/g or 0.8 mg/g.

Typical use

One gram is applied to the vagina nightly for 7 nights (sometimes 10 nights if there is very severe atrophic vaginitis); then the dosage is reduced to 2–3 times per week for long-term maintenance. A small amount can be used on the vulva and opening to the vagina (introitus).

Pros

Estriol vaginal cream is a good first choice, since it is the gentlest option and may be safest where there are breast cancer concerns.

This low-potency cream will gradually help tissue both inside and outside the vagina, and can also be applied directly to the vulva and urethral tissue. Results may be seen in just 1–2 weeks.

Estriol vaginal cream can also be custom-compounded to include a small amount of testosterone. Many women respond best to this combination.

Cons

Some complain that the cream feels messy — especially during the first week of nightly use.

You have to remember to use it to maintain results, and it’s not intended as a personal lubricant for sexual intercourse.

Availability

Estriol vaginal cream is custom-compounded only by special prescription order from your provider. Women’s International Pharmacy is a great source and offers very affordable pricing, since insurance companies do not always cover this product.

Vagifem vaginal inserts

Contents

Vagifem estradiol vaginal tablets are small, white, film-coated tablets containing 25.8 mcg of 17ß-estradiol hemihydrate, equivalent to 25 mcg of estradiol. They are provided in boxes of 8 or 18 tabs with an applicator.

Typical use

One insert is used in the vagina each night for 7–14 nights, and then reduced to one insert two nights per week for maintenance.

Pros

This product is not messy, is easily inserted, and is effective for rejuvenating the vaginal tissues. In time, the vulva should also respond.

Cons

Vagifem may not work as quickly as creams do to the external tissues of the vulva and outer portion of the vaginal opening.

You have to remember to use it regularly to maintain results.

It is not intended for use as a lubricant prior to sexual intercourse.

Availability

This brand name product is available by prescription through regular pharmacies.

Estrace vaginal cream

Contents

Estradiol vaginal cream, USP, 0.01%

Typical use

One gram is applied to the vagina nightly for 7 nights (sometimes 10 nights for very severe atrophic vaginitis), then reduced to 1–3 times per week for long-term maintenance. Massaging small amounts to the vulva and inner labia can also be very helpful, though this may not be mentioned on the prescription or insert directions.

Pros

Results are seen in just 1–2 weeks, but it may take longer for peak results. This product is very good to use prior to trying the Vagifem inserts or 90-day rings, since it can also be applied to the vulva.

Cons

Some complain that it feels messy, especially that first week of nightly use. You have to remember to use it to maintain results, and it isn’t intended for use just prior to sex.

Some women report burning from the base used in this product. (A compounding pharmacy can duplicate this cream in a more hypoallergenic, pH-balanced base for improved comfort.)

Availability

This brand name product is available by prescription through regular pharmacies.

Estring 90-day vaginal ring

Contents

Estring (estradiol vaginal ring) is a silicone-based ring containing 2 mg estradiol. Estring releases estradiol (approximately 7.5 mcg/24 hours) in a consistent stable manner over 90 days.

Typical use

One ring is inserted into the vagina and remains there for 90 days. After 90 days, it is removed and replaced with new ring.

Pros

This device delivers a nice low dose of estradiol for 90 days of use without any adjustments needed.

It can help provide support to the vaginal walls in women whose pelvic floor muscles are weak.

Cons

It does require some degree of dexterity to insert and remove. Some women are not comfortable with insertion or removal and choose to see their practitioner every 90 days to have it done for them.

While some women find an Estring comfortable, others don’t like the feel of wearing this or any ring-like device. The use of Estrace vaginal cream for one month prior to initial insertion of an Estring can improve comfort level.

Availability

This brand name product is available by prescription through regular pharmacies.

Femring 90-day vaginal ring

Contents

Femring (estradiol acetate vaginal ring) is a soft, flexible silicone-based ring containing time-released estradiol acetate. Two strengths are available for Femring: 0.05 mg/day and 0.10 mg/day, the latter usually requiring special order. Both strengths release estradiol acetate every day for 3 months for system-wide estrogen replacement therapy (not just vaginal treatment).

Typical use

One ring is placed into the vagina for 90 days and then removed and replaced as needed.

Pros

The Femring is softer and more pliable than the Estring, and thus easier to insert and remove for some women. It can provide support to the vaginal walls where pelvic floor muscles are weakened.

Cons

Because it requires insertion and removal, women who aren’t comfortable doing so have to visit their practitioners every 90 days to have it done for them.

The feeling of wearing a ring-like device can also be uncomfortable for some women.

For those women with a history of endometriosis, the Femring may cause flare-ups of endometriosis discomfort because of the strong estrogen delivery directly within the pelvis.

Note

The Femring product supplies estradiol to the vagina and the general circulation at a potency similar to an estradiol patch for treatment of both vasomotor (e.g., hot flashes) and vaginal symptoms. It is not a low-dose treatment localized to the vagina tissues only, but a form of systemic (system-wide) hormone replacement therapy. If you have a uterus, a prescription-strength progesterone product, such as Prometrium, must be used in conjunction with this product.

Availability

This brand name product is available by prescription through regular pharmacies.