There are many treatments to help relieve vaginal symptoms. For all options, there are risks and benefits. Talk to your doctor about these risks, benefits, and side effects before you start any medication.
Prescription medications used for vaginal symptoms of menopause are tablets, creams, and rings that supply estrogen directly to the vagina rather than through the bloodstream like pills, skin gels, or patches. They help relieve symptoms and reverse some of the changes caused by low estrogen levels.
Products available in Canada include:
- vaginal estrogen tablets: estradiol 17-β (Vagifem® 10)
- vaginal estrogen ring: estradiol 17-β (Estring®)
- vaginal estrogen cream: conjugated estrogens (Premarin® Vaginal Cream) and estrone (Estragyn® Vaginal Cream)
Vaginal estrogen tablets
Vaginal estrogen tablets (Vagifem® 10) are placed into the vagina using a pre-filled disposable applicator (supplied in the package) similar to the way a tampon is inserted. Once in the vagina, the tablet dissolves to create a gel layer that clings to the walls of the vagina. It is recommended that for the first 2 weeks, the tablets are inserted daily. After this, they are inserted only twice a week. Side effects may include skin rash, vaginal bleeding, genital itching, and vaginal discharge. The vaginal estrogen tablet is unlikely to affect or be affected by other medications, as only a very tiny amount of estrogen is absorbed into the bloodstream.
Vaginal estrogen ring
The vaginal estrogen ring (Estring®) is a flexible plastic ring that is inserted high into the vagina once every 3 months. The ring has a core inside that slowly releases estrogen into the surrounding area for 90 days. You can insert the ring yourself or ask your doctor to do it. Side effects may include vaginal discomfort, abdominal pain, back pain, headache, genital itching, or leg swelling. The vaginal estrogen ring is unlikely to affect or be affected by other medications, as only a very tiny amount of estrogen is absorbed into the bloodstream.
Vaginal estrogen cream
Vaginal estrogen cream (Premarin® Vaginal Cream, Estragyn® Vaginal Cream) is inserted into the vagina using an applicator daily for 3 weeks, followed by one week without treatment. It should be used at bedtime so that there is less leakage of the cream. Side effects may include headache, breast pain, irregular vaginal bleeding or spotting, stomach cramps or bloating, nausea and vomiting, or hair loss. Some women may also notice vaginal burning, irritation, itching, or discharge.
Because some estrogen can be absorbed into the bloodstream from vaginal estrogen cream, doctors may recommend that women who have a uterus take a progestin for 10 to 14 days of the month. The vaginal estrogen cream is unlikely to affect or be affected by other medications, as only a very tiny amount of estrogen is absorbed into the bloodstream.
Vaginal moisturizers and lubricants
Non-prescription treatments are also available to help relieve vaginal symptoms, including:
- polycarbophil gel (Replens®): This vaginal moisturizer relieves dryness, itching, irritation, and pain during sex, but won't reverse the changes caused by urogenital aging. Use it every 2 to 3 days, as needed.
- lubricants: Lubricants can decrease vaginal irritation during sex, but they don't have long-term effects on vaginal dryness, irritation, or urogenital aging . Use as needed during sex.