Q: Is there an alternative to estrogen cream?

You say you “can hardly fit a finger” in your vagina and recognize other signs of vaginal atrophy. This is a very common condition, affecting the majority of postmenopausal women. Unfortunately, this condition is what we call “chronic and progressive,” meaning it will only get worse.

You wonder whether you could achieve the same results with lubricants and dilators as with the localized estrogen cream that your doctor recommends. Lubricants typically can help a woman feel more comfortable during intimacy, but they don’t contribute to tissue health (beyond minimizing friction). The use of moisturizers is helpful in prevention of vaginal atrophy, but they are not really helpful in treatment. Once the vagina is atrophic and has lost elasticity, vaginal dilators are not very effective. The vagina needs to be healthy, meaning elastic and with more blood supply and moisturized, for the dilators to be effective.

“Estrogenizing” the vagina (I put this in quotes because there are also some non-estrogen options for treatment) is the most effective treatment and it’s safe. There are honestly no noted risks for this. The estrogen is delivered to the vagina only, not systemically (which does mean no benefit to brain or bone, for instance). We can’t detect blood levels of estrogen above the normal low-menopausal range. We use localized estrogen in our breast cancer survivors.

Once the vagina is estrogenized, then dilators can be used successfully.

I hope this is helpful and gives you hope for a return to a satisfying sex life!