What you describe is a natural result of the loss of natural estrogen through menopause. There are a number of localized estrogen options, including Estrace and Premarin creams, Vagifem tablets inserted in the vagina, and Estring, which is a ring also placed in the vagina.
The therapeutic dose of Estrace is 1 gram applied to the vagina and vulva two times a week; using less than that will be, as we doctors say, "subtherapeutic," which means it won't have sufficient effect! While the creams are effective when used as prescribed, many of my patients prefer and get more consistent doses from the ring or tablets.
You mention a family history of breast cancer. None of these options is "systemic," which means that they can be used by women with breast cancer risk factors--even by some breast cancer patients. There's a new option, too, that's non-estrogen: Osphena is an oral daily medication that showed "statistically significant improvement" in vaginal and vulvar pain.
Moisturizers and lubricants can also help to increase comfort while a full treatment plan is taking effect.
It takes attention and consistency to regain comfort after being sexually inactive, but I'm sure you'll find it's worth the effort!
Dr. Barb DePree, M.D., has been a gynecologist and women’s health provider for almost 30 years and a menopause care specialist for the past ten.
2 comments
Interesting that you mention that your patients prefer the ring or tablets. Given the choice of the 3 methods of delivery of the estrogen I thought I would prefer the ring with the tablet coming in second. But the ring is quite small in circumference, it is very expensive with a copay of $90 where I live, and comes with a warning it can fall out during a bowel movement. At $90 a pop plus you can’t just go get another if catastrophe happens unless it is time for a new one anyway, it is just not my first choice any more.
As a provider we try to take into consideration on examination the ‘pelvic floor’ and assess the tone (or lack of) because for some women there is significant weakness and the likelihood of the ring falling out is then obviously greater. Most women do very well with the ring and love the ‘low maintenance’ aspect, but there are a variety of options to consider, with patient preference an important consideration!