Menopausal Vaginal Dryness Treatment

The tissues of the vagina are very sensitive to the female hormone oestrogen. This keeps these tissues moist and elastic. It also stimulates the production of glycogen. This helps to regulate the natural vaginal bacteria and protects against infections.
Around the Peri-Menopause/ Menopause, oestrogen levels fall and can trigger uncomfortable vaginal & genital symptoms. These symptoms are very common and can persist ongoing for many women.
Unfortunately, this is not something that is frequently discussed and, as a result, is underdiagnosed and undertreated.

• When levels of oestrogen are low, vaginal tissues do not produce as many natural secretions (to lubricate and protect the vagina). The tissues can become dry, leading to soreness, burning and itch. This can cause pain during vaginal sex, discomfort when active/ moving or when having your smear test.
• Lower levels of oestrogen alter the natural vaginal bacteria, which can lead to increased vaginal infections such as thrush and bacterial vaginosis.
• Vaginal discharge can also increase during Menopause. This can be a later sign of significant vaginal dryness; the tissues become so dry and fragile that secretions leak through the thinning vaginal walls.
  If there are changes to secretions it is best to attend for examination to exclude infection before starting hormonal treatment.

• Decreased oestrogen levels also lead to thinning and weakening of the tissues in the pelvic floor, so the muscles that support the bladder and the urethra become weak. This can lead to urinary symptoms:
  • Poor bladder control (urine frequency and urgency)
  • Recurrent urine infections
  • Sensation of an infection  (despite negative urine tests).

To help with symptoms of vaginal dryness:

• Avoid vaginal douching
• Avoid tight fitting clothing
• Wear cotton underwear
• Check the products you are using. The following can contain vaginal irritants that will make symptoms worse: Perfumes, soaps, powders, deodorants, panty liners, spermicides and some vaginal lubricants
• Vaginal moisturisers used on a regular basis can provide symptom relief, vaginal lubricants are intended for use during penetrative sexual activity. Both can be used with topical oestrogen treatments but should be used at different times.

The main aim of treatment is to relieve symptoms.

As these symptoms are caused by a lack of oestrogen in the vaginal tissues, locally replacing this oestrogen can be very effective, and other treatments may not be required.

If clinically appropriate, we can provide a prescription for vaginal oestrogen tablets.

We are not able to offer prescriptions for other hormonal treatments via this service.

These are vaginal tablets that contain a type of oestrogen, helpful in the treatment of local vaginal symptoms associated with hormonal changes related to menopause. It is a type of hormone replacement.

Please be aware that this type of treatment will not help with more generalised menopausal symptoms e.g. hot flushes, night sweats, mood problems.

While it is a type of HRT, it is considered to be very safe as it only acts on the vaginal tissues and contains a very low dose of hormone; using the vaginal tablets for one year is equivalent to approximately the same oestrogen dose as one oral oestrogen HRT tablet.

When using vaginal oestrogen tablets, the level of oestrogen in the blood is the same as menopausal women who are not using vaginal oestrogen, so there is no significant risk of concerning side effects such as breast cancer, blood clots and heart disease compared with other oestrogen treatments (oral HRT & combined contraceptive pill).

Vaginal tablets are easy to use. They come with an applicator and a set of instructions to guide you.

You insert one tablet into the vagina every night for two weeks, and then twice weekly after this. There is an applicator to help with the correct insertion of the vaginal tablet.

We can issue a prescription for 24 vaginal tablets (one packet) if you have not used this before (initial prescription), and 48 tablets (6 months) if a repeat prescription is being issued.

If this is your first time using this treatment, you should complete an initial course of vaginal tablets (one every night for 14 nights, then one twice weekly for the remainder of the packet) and if effective, arrange a repeat prescription for ongoing symptom relief.

The most common side effects of Vagifem are:

• Vaginal discomfort/ stinging 
• Vaginal bleeding/ discharge
• Headache
• Stomach pain

IMPORTANT

Please be aware that the patient information leaflet for this product contains out-of-date information. Many of the side effects and risks listed relate to oral oestrogen treatments and not to topical treatments which are very low risk. It is considered safe to take long-term vaginal oestrogen products, and some women may need to use this long-term to manage their symptoms. 

For further information about this treatment, there are links below to some useful and reliable websites. 

Please note that some of the products discussed are not available via our service and you should speak with a doctor directly if you have any questions about these. 

Vaginal Dryness (Atrophic Vaginitis) | Causes and Treatment | Patient 

Balance Menopause

You can stop it after this if you feel better, but often symptoms return. If this happens, you can continue to use this treatment long-term.

It is very important to let any doctor treating you know that you are using this medication so that your risk can be reassessed if anything significant changes in your medical history.

If your symptoms do not improve, worsen or change during this time then you should arrange a review with a doctor for a physical examination.

Please note if you develop any unexpected/ unexplained vaginal bleeding when using this treatment at any time, you should arrange an assessment with your doctor as a priority.

Systemic hormonal replacement therapy (HRT) such as patches, gels or tablets can help to control multiple symptoms of Menopause, including vaginal dryness. However, in some women additional vaginal oestrogen is all that is required to appropriately control vaginal specific symptoms. This can also be used with systemic HRT preparations if more localised treatment is needed.

If you have had any unexpected/ unexplained vaginal bleeding in the past 12 months, you should not make a decision about using this treatment until this has been investigated, and a cause has been identified. This treatment may settle or mask the symptoms of a potentially serious cause of the bleeding.

If you develop unexpected or unexplained bleeding while you are using vaginal oestrogen, you should stop your treatment and arrange a physical examination with your doctor.