8 Treatments for Vaginal Atrophy
A diagnosis of vaginal atrophy (VA), or genitourinary syndrome of menopause, is incredibly common—estimates differ because many cases might go undiagnosed, but it could impact more than half of all post-menopausal women and many perimenopausal women, too. So you’re not alone if you have it—and there is help. Treatments can improve VA’s symptoms, no small thing when you’re experiencing pain during sex, vaginal dryness, problems when you pee, and the many other problems that accompany it. Here, experts share eight ways to help tackle the condition.
Lubricants Can Help During Sex
Water or silicone-based lubricant is one of the most common solutions for women who experience vaginal pain and dryness during sex that accompanies VA. When it comes to choosing a formula, “I would just say that whatever women find works for them and they don’t react to as is ideal,” says Stephanie Faubion, M.D., professor and chair of the department of medicine at Mayo Clinic in Jacksonville, FL, and medical director for The North American Menopause Society. To help ensure that second point, she says to look for one without glycerin, parabens, or petroleum.
Moisturizers Help Daily
Much like lotions for the rest of your body, vaginal moisturizers replenish moisture in the skin. And these bioadhesive treatments bind to the area so they stay put. Used every few days up to everyday depending on the need, “I tell patients to use it on a regular basis, and put it on after they get out of the shower,” says Dr. Faubion.
Hormone Therapy Treats the Root Cause
A major treatment for VA addresses the main reason it happens—the natural loss of estrogen in menopause—by adding estrogen back to the area via topical hormones. “There are many types of topical estrogens including creams, gels, and sprays,” says Brittany Robles, M.D., an obstetrician-gynecologist at Wyckoff Hospital in Brooklyn, NY, but when it comes to which one to use, “there isn't any particular reason why one would be selected over another. They are all equally effective,” she says. It all comes down to patient preference. Talk to your doctor about which one might be a good treatment for you.
A Pill Can Now Replace Estrogen, Too
Ospemifene (Osphena), an oral selective estrogen receptor modulators (SERM) medication, was approved in 2019 for the treatment of pain during intercourse by helping to increase vaginal wall thickness. Ask your doctor if it’s a good option for you, as it’s not recommended for people who have a history of certain cancers, and Dr. Faubion points out that it comes with a slight increased risk of blood clots.
A Prescription Vaginal Suppository Might Work for You
When slipped in once a day at bedtime, Prasterone (Intrarosa), a prescription vaginal suppository, gives you a dose of dehydroepiandrosterone. Also known DHEA, this is an endogenous steroid hormone precursor that helps the body produce estrogen (among other hormones). In a study published in The Journal of Sexual Medicine, researchers found that it reduced moderate to severe post-menopausal sexual pain after 12 weeks of use. Make sure to tell your doctor if you’d had cancer or are breastfeeding before taking.
Or You Just Might Need Systemic Hormone Therapy
While topical estrogen (known as “local therapy” because they’re not absorbed by the whole body) is often enough to help women with VA, for people who just aren’t getting enough help from those creams and gels and/or who experience vasomotor symptoms of menopause like hot flashes and night sweats, systemic hormone therapy (which goes throughout the body, not just the vagina) might be prescribed. Also known as hormone replacement therapy, according to Dr. Robles, your doctor may prescribe you progesterone to, she explains, “help balance out the hormonal effects.”
Rehabilitation, Including Dilators, Can Reduce Symptoms
Physical therapy (PT) with both pelvic floor rehabilitation and dilators can be helpful to some. “If you have pelvic floor muscles that have gotten really tight and tender because of ongoing pain, those muscles are just a tight ball,” Dr. Faubion says. Together with a therapist, you can work to gently stretch those tissues and relax the muscles. Ask your doctor if they can recommend a good PT to work with.
Lasers Might Be in Our Future
While to date there are no vaginal laser devices or procedures cleared by the U.S. Food and Drug Administration for vaginal atrophy, it’s a treatment to look for in the future. “There are studies that are out there that are promising,” Dr. Faubion says. “We just don’t have long-term data on safety or advocacy.” Keep your eyes open for more research on these lasers, including the fractional CO2 laser.
Make Sure Your Partner Receives Any Needed Treatment
While so much of the focus in treating a couple often goes to the women with VA, any concerns on the partner side should also be considered. In heterosexual relationships, “making sure your partner is treated for erectile dysfunction is important,” Dr. Faubion says. “It can make the situation worse because he is going to be using the friction to maintain his erection.” Ouch. So get your guy checked out, too.
Unreported VA: International Journal of Women’s Health. (2018). “Current treatment options for postmenopausal vaginal atrophy.” ncbi.nlm.nih.gov/pmc/articles/PMC6074805/
About Vaginal Atrophy: The Cleveland Clinic. (2020.) “Vaginal Atrophy.” my.clevelandclinic.org/health/diseases/15500-vaginal-atrophy
Symptoms: Cureus. (2020). “The Genitourinary Syndrome of Menopause: An Overview of the Recent Data.” ncbi.nlm.nih.gov/pmc/articles/PMC7212735/
VA Treatment Options: Contemporary OB-GYN. (2018). “Genitourinary Syndrome of Menopause: Underdiagnosed and Undertreated.” contemporaryobgyn.net/view/genitourinary-syndrome-menopause-underdiagnosed-and-undertreated
Hormone Therapy and Other Treatments: Cleveland Clinic. (2020). “Vaginal Atrophy: Management and Treatment.” my.clevelandclinic.org/health/diseases/15500-vaginal-atrophy/management-and-treatment
Prescription Vaginal Suppository: The Journal of Sexual Medicine. (2015). “Effect of Intravaginal Prasterone on Sexual Dysfunction in Postmenopausal Women with Vulvovaginal Atrophy.” pubmed.ncbi.nlm.nih.gov/26597311/