Many women suffering from vaginal dryness find relief by using locally-applied,
natural estrogen products. As opposed to oral HRT, locally-applied
bioidentical estrogen can help persistent vaginal dryness without passing
large amounts of estrogens throughout the rest of your system. With most of the
products below (with the exception of the Femring), only
minimal amounts of estrogen enter your body’s circulation, so they are generally
considered a safer option than oral (systemic) hormone therapy.
Of course, we always recommend proper evaluation and monitoring by your gynecologist
to ensure no condition
associated with vaginal dryness exists, and to ensure improvement of your
condition. But before you go, be aware that the first-line approach to vaginal dryness
for many conventional doctors involves a prescription for Premarin Vaginal Cream.
This is a product containing conjugated equine estrogens, hormones that
are not natural to the human female body. Fortunately, there are many safe biodentical
estrogen options for localized treatment of vaginal dryness, and they are equally
if not more effective.
The three main bioidentical estrogens are estrone (E1), estradiol (E2),
and estriol (E3). Currently pharmaceutical companies manufacture estradiol-based
bioidentical vaginal products, but you need to know which ones to ask for. The charts
below list the vaginal dryness treatments we prescribe most often at Women to Women’s
Healthcare Center, along with a few nonhormonal, over-the-counter
products that can be used in addition to bioidentical estrogen or on their
own to soothe delicate vaginal tissues.
This chart is intended to help you understand what options exist when having a conversation
with your healthcare provider about topical bioidentical estrogen for vaginal dryness.
See our full article on vaginal dryness
for a more in-depth discussion.
PRESCRIPTION ESTROGEN PRODUCTS*
for VAGINAL DRYNESS
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Estriol vaginal cream
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Contents
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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.
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Typical use
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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).
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Pros
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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.
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Cons
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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.
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Availability
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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.
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Vagifem vaginal inserts
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Contents
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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.
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Typical use
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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.
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Pros
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This product is not messy, is easily inserted, and is effective for rejuvenating
the vaginal tissues. In time, the vulva should also respond.
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Cons
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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.
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Availability
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This brand name product is available by prescription through regular pharmacies.
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Estrace vaginal cream
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Contents
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Estradiol vaginal cream, USP, 0.01%
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Typical use
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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.
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Pros
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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.
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Cons
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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.)
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Availability
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This brand name product is available by prescription through regular pharmacies.
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Estring 90-day vaginal ring
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Contents
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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.
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Typical use
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One ring is inserted into the vagina and remains there for 90 days. After 90 days,
it is removed and replaced with new ring.
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Pros
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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.
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Cons
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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.
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Availability
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This brand name product is available by prescription through regular pharmacies.
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Femring 90-day vaginal ring
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Contents
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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).
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Typical use
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One ring is placed into the vagina for 90 days and then removed and replaced as
needed.
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Pros
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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.
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Cons
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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.
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Note
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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.
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Availability
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This brand name product is available by prescription through regular pharmacies.
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* Note: Since pharmaceutical companies’ brand name products
are all FDA-approved and regulated, they come with the same intimidating warnings
that the FDA insists go on all estrogen products. There is growing evidence to suggest
that delivery of low-dose estradiol either percutaneously (meaning “across
the skin”) or transvaginally (through the walls of the vaginal tissue)
does not increase the risk for blood clotting to the degree that oral estrogen
does. Yet the warning labels are still required on all estrogen products.
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There are several nonhormonal products available that women with vaginal dryness
may find soothing. Over-the-counter products for vaginal dryness can be used intermittently
as needed, in-between or in addition to prescription bioidentical estrogen. Some
women seem to have tried everything without success, and for them, or for the breast
cancer patient who is to fearful of trying vaginal estrogen, we suggest a manual massage with some type of lubricant.
Remember to check the product labels to be sure the one you choose contains no harsh
chemical ingredients, petrochemicals, endocrine disruptors, or irritants to which
you may have a sensitivity, such as alcohol, parabens, or propylene glycol. The
chart below lists a few that have been used safely with good results by Women to
Women patients and Personal Program members.
OVER-THE-COUNTER PRODUCTS for VAGINAL DRYNESS
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Vitamin E vaginal suppositories
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Vitamin E vaginal suppositories are available through Women to Women’s Personal
Program. These are great for women who are not using prescription products or for
use on nights when you are not using a prescription estrogen product. (Choose only
natural-source vitamin E products.)
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Natural oils
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Natural oils, such as grapeseed, sweet almond, sunflower or apricot, can be very
soothing for use during or after bathing or sexual intercourse.
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Sylk
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Sylk is another natural personal lubricant many women like. Made from an extract
of the kiwifruit vine, Sylk contains no parabens or propylene glycol.
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Astroglide
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Astroglide is a personal lubricant helpful for reducing friction and discomfort
during sexual intercourse. It’s available in a glycerin-free and paraben-free
formulation.
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Our Personal Program is a great place to start
The Personal Program promotes natural hormonal balance with nutritional supplements,
our exclusive endocrine support formula, dietary and lifestyle guidance, and optional
phone consultations with our Nurse–Educators. It is a convenient, at-home
version of what we recommend to all our patients at the clinic.
If you have questions, don't hesitate to call us toll-free at
1-800-798-7902. We're here to listen and help.
We’re always happy to welcome new patients to our medical clinic in Yarmouth,
Maine, for those who can make the trip. Click
here for information about making an appointment.