About vaginal symptoms
After menopause, the tissues of the vagina can become thinner and less elastic, and the vagina can become narrower. This can lead to symptoms such as:
- vaginal dryness, discharge, or bleeding
- difficult or painful sexual intercourse
Up to 55% of women suffer from vaginal symptoms of menopause. For women who have other menopause symptoms, such as hot flashes, in addition to their vaginal symptoms, doctors may recommend a different form of estrogen, such as an oral pill, patch, or gel. These don't always relieve vaginal symptoms; it is estimated that approximately 40% of women taking adequate doses of oral estrogens still have vaginal dryness.
The main 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 as do 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®)
- vaginal estrogen ring: estradiol 17-β (Estring®)
- vaginal estrogen cream: conjugated estrogens (Premarin® Vaginal Cream) and estrone (Neo-Estrone® Cream)
Vaginal estrogen tablets
Vaginal estrogen tablets 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, 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 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 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.