Q: Is there an alternative to HRT to combat vaginal atrophy?

You say you have not been sexually active for several years, and that recently a Pap test was painful to endure. Your doctor diagnosed vaginal atrophy. For reasons of your own health history and your family’s, you’re reluctant to use HRT (systemic hormone replacement, now called HT for hormone therapy).

Vaginal atrophy is a condition we characterize as chronic and progressive. It will not improve on its own and will get more uncomfortable over time. Initiating treatment sooner than later is usually advisable. Many treatments (like vaginal moisturizers) that maintain vaginal health are not effective at restoring vaginal tissues.

If you want to try a vaginal moisturizer as a first step, I’d recommend Lubrigyn Cream as a good option. It contains hyaluronic acid and elastin to maintain and support the tissue structure. We have other options in our shop if you’d like to experiment.

Localized estrogen--applied vaginally--is among the most effective ways to restore the integrity of an atrophic vulva/vagina. I do understand your hesitation about systemic hormones, but localized hormones don’t carry the same risk factors (it’s an option for breast cancer survivors, for example). And if your only menopause symptom is vulva/vagina-related then a localized treatment option is usually a great choice.

Osphena, a non-estrogen oral, daily treatment, is another prescription option that has been effective for my patients in restoring vaginal comfort. Here’s a blog post I published when it was first approved, and I’ve been using it successfully in my practice since.

You also asked about the MonaLisa Touch treatment, which uses laser treatment to stimulate the vagina to make collagen and develop a new layer of vaginal tissue. I don’t have direct personal experience with it, but have investigated it for my practice and find the research compelling. Pain and side effects are minimal, and the treatment appears to provide relief to 85 to 90 percent of women who have it. Definitely worth discussing with your health care provider!

Your age seems to be young to consider never experiencing a normal sex life again! (I admit that my threshold for expectation rises with my own age, but more treatment options are available each year.) With some effort, I’m quite certain you can revive that part of your life.