Vaginal Dryness in Menopause: What to Know About Vaginal Estrogen

A common change that often goes unmentioned

Vaginal dryness, irritation, discomfort during sex and needing to urinate more often are some of the most common changes of perimenopause and menopause. They are also among the least talked about. Many women assume they simply have to live with them, or feel awkward raising them at an appointment that is already full of other questions.

These changes have a name, the genitourinary syndrome of menopause (GSM), and they are a routine topic for clinicians who care for women in midlife. If they are affecting you, they are worth bringing up.

Why it happens

The tissues of the vagina, vulva, urethra and bladder are rich in estrogen receptors. As estrogen levels fall in the years around menopause, those tissues can become thinner, drier and less elastic. Unlike hot flashes, which often ease with time for many women, these changes tend to persist, which is one more reason they are worth a conversation rather than waiting them out.

What local vaginal estrogen is

Vaginal estrogen is estrogen applied directly to the vaginal tissue, most often as a cream. It works where it is placed, which is why clinicians describe it as local therapy. That makes it different from systemic hormone therapy, such as a topical estradiol applied to the skin, which is meant to reach the whole body.

The Menopause Society's position statement on GSM describes low-dose vaginal estrogen as an established treatment option. Because it is local, many women who are not using systemic hormone therapy talk with their clinician about vaginal estrogen on its own, and some use both.

Whether it is right for you, which estrogen, and how often to use it are decisions for you and your prescriber.

Estradiol, estriol and compounded options

Two estrogens are commonly prescribed for vaginal use:

• Estradiol, the main estrogen the ovaries make before menopause
• Estriol, an estrogen the body makes in larger amounts during pregnancy. It is not available as a commercially manufactured product in the United States, so it is prepared by compounding pharmacies

A prescriber may choose a compounded vaginal preparation to use estriol, to combine estriol with DHEA in one cream, or to use a base without ingredients a patient reacts to. We also prepare a hyaluronic acid vaginal base.

How we can help

At ProCompounding we prepare vaginal preparations to order for each patient, at the strength and in the base your prescriber specifies:

• Estradiol vaginal cream
• Estriol vaginal cream, including estriol combined with DHEA
• A hyaluronic acid vaginal base
• Hypoallergenic, dye-free and filler-free options for women with sensitivities

A pharmacist reviews every formulation before it is made. Our women's health page covers the full range of hormone preparations we compound, and if your estradiol patch has been hard to find, our guide to estradiol patch alternatives explains the options a prescriber may consider.

Bringing it up with your prescriber

If it helps to have the words ready, you might say: "I've been having vaginal dryness and discomfort, and I'd like to talk about whether local vaginal estrogen could be an option for me." Our guide on how to ask your doctor about compounded medication has more on starting that conversation.

Getting it filled

1. Your prescriber sends the prescription to ProCompounding.
2. Already have a prescription at another pharmacy? Transfer it to us and we will handle the rest.
3. We compound it with a 48-hour compounding time on most preparations. Shipping time is additional.

We are licensed in all 50 states and the District of Columbia, and we are PCAB accredited. Call 423-975-0597 for current pricing and shipping options for your state.

Compounded preparations are not reviewed or approved by the FDA for safety or efficacy. This article is for education and reflects what we see in clinical practice; it is not medical advice. Decisions about your care rest with your prescriber.