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Hormone Therapy: Help for Vaginal Dryness

Hormone Therapy: Help for Vaginal Dryness
Vaginal dryness can affect women at any age ó and put a damper on sexual activity. Fortunately, there are treatment options that help replace natural lubrication
Vaginal dryness can make sex more than uncomfortable ó it can be extremely painful. Having a dry vagina is common during menopause, but women of any age can experience a lack of lubrication ó vaginal dryness is associated with low libido and problems with arousal before menopause, too.

A dry vagina is a problem that can be remedied. A variety of treatments on the market include over-the-counter vaginal lubricants and hormone replacement products for after menopause that can make having sex enjoyable again.

When Vaginal Dryness Happens

How you experience vaginal dryness depends on your age. For premenopausal women, dryness tends to be an issue only during intercourse, says Inga Zilberstein, MD, an obstetrician-gynecologist in private practice in New York City. The dryness could be a problem of arousal or due to an infection. Donít ignore premenopausal vaginal dryness if itís truly a persistent problem, Dr. Zilberstein warns. If itís the result of an infection, you should see your doctor for treatment. If youíre having difficulties becoming aroused, a sex therapist can help you unlock the emotional reason for it, she adds.

Women who have been through menopause may have vaginal dryness even when they are aroused for intercourse. They may also experience itching and burning when theyíre not having sex, Zilberstein says.

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Vaginal dryness affects most women after menopause because of a drop in estrogen levels, she explains. One way to try to avoid it is to continue to be sexually active during menopause. When thereís a large gap in your sexual activity, thereís more of a chance youíll experience dryness.

Vaginal Lubricants for Premenopausal Relief

If youíre premenopausal, a vaginal lubricant may be all you need. There are many brands and types to choose from, including water-based lubricants such as K-Y Jelly and Astroglide, silicone lubricants like Pink, and organic lubricants such as Good Clean Love.

Another option is Zestra, also a drugstore product, made of botanical oils that cause tingling near the clitoris, says Carolyn Nemec, MD, a womenís health specialist at Cleveland Clinic Willoughby Hills Family Health Center in Willoughby Hills, Ohio.

Pros: Lubricants can jumpstart arousal, Dr. Nemec says. Theyíre also easy to find at your local pharmacy and online.
Cons: Some vaginal lubricants can cause skin reactions in some women, especially warming gels, Nemec says.
Vaginal Lubricants for Postmenopausal Women

After menopause, the loss of vaginal lubrication is due to estrogen loss. There are options for replacing estrogen, but estrogen replacement carries certain cancer risks and its use must be carefully evaluated by having a thoughtful and candid conversation with your doctor. Only a small amount of estrogen applied topically to the vagina makes it into your bloodstream. However, if you have a history of breast cancer or are at risk for estrogen-dependent breast cancer, itís very important to talk to your doctor about the possible risks of using estrogen as a treatment.

Estrogen replacement products include:

Estrogen cream. Estrogen creams and conjugated estrogens such as estradiol (Estrace, Femring, Premarin, and others) can be applied to the vagina two or three times a week to help alleviate dryness, and then once a week or every so often for maintenance, Zilberstein says.

Pros: Itís convenient because you can use it as needed (but not during intercourse).
Cons: You may feel side effects such as breast tenderness from the small amount of estrogen thatís being absorbed into your system, Zilberstein says. Also, women tend to experience a peak in the creamís effectiveness a few hours after applying it, and then the estrogen concentration falls.
Estrogen ring. Estradiol vaginal ring is a plastic ring containing estrogen that you insert into your vagina. It releases a small amount of estrogen every day and can stay in place for up to three months.

Pros: It releases a consistent amount of estrogen into the vagina and doesnít cause the peaks in estrogen the way creams do, Zilberstein says. The makers of estradiol also claim the estrogen in the ring isnít absorbed into the system.
Cons: You and your partner may feel the ring during intercourse, and that may be bothersome. You can remove the ring before sex and put it back in afterward, Zilberstein says.
Estrogen tablet. Estradiol vaginal tablets are inserted into the vagina with an applicator. Itís used once a day for the first two weeks and then twice a week afterward.

Pros: It offers another option for women who donít want to wear the estrogen ring or be bothered with the mess of a cream.
Cons: Like estrogen creams, the tablets can cause a peak in effectiveness and then drop. Also, small, grainy pieces of the tablet may come out of the vagina as a discharge, Zilberstein says.
Estrogen patch. Estrogen patches, including the generic estradiol patch and brand names, such as estradiol/levonorgestrel transdermal system (Climara Pro), estradiol transdermal system (Vivelle-Dot), and others, are not applied vaginally, but are placed on your stomach or buttocks for three to seven days and then replaced. These patches help manage many menopausal symptoms, such as night sweats and hot flashes, in addition to symptoms of vaginal dryness.

Pros: Because the estrogen is delivered through the skin, a smaller amount can be used as compared to oral estrogen replacement therapy, says Zilberstein.
Cons: Some women say they canít use the patch because it falls off too easily. Others have an allergic reaction to the patch material. Depending on your breast cancer risk factors, your doctor may not want you to be exposed to this much circulating estrogen.
Although vaginal dryness is common, there are solutions. Talk to your doctor about the best choices for your personal situation and medical history.