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LHJ: So vaginal dryness is directly linked to decreasing estrogen?
LS: Exactly. As estrogen levels go down, the production of the clear fluids that provide natural lubrication start to diminish. The pH of the vagina rises too, which creates a more alkaline environment in which bad bacteria are more likely to thrive. This is what causes common symptoms like a foul odor, irritation and an abnormal, watery discharge.
LHJ: Aren't these the same symptoms as a vaginal yeast infection?
LS: They're similar, so it's no surprise that many women run to the drugstore to try an over-the-counter yeast infection medication. This can feel soothing for a very short time, but inevitably the symptoms return. Interestingly, a lot of women will describe what they're feeling as "itching" but when you really ask for details, it turns out they're not experiencing itching so much as burning and irritation, often inside and outside the vagina.
LHJ: Does the problem have a name?
LS: It's called atrophic vaginitis, but it's not an infection. And it is totally reversible. To repair the problem, a woman can use one of three different types of vaginal estrogen. All work equally well to revitalize the vaginal walls and rev up lubrication -- in many cases, you can stop treatment altogether after a few months once your symptoms are resolved.
LHJ: Are we talking about a form of hormone replacement?
LS: Essentially, yes, but with vaginal estrogen there's minimal absorption into the bloodstream. These products are considered safe even for breast cancer survivors. (And you don't need progesterone with this as you would for birth control or hormone therapy if you haven't had a hysterectomy.)
LHJ: What are the choices -- and why would a woman prefer one over the other?
LS: There's a vaginal estrogen ring, which is super convenient. You insert a soft, flexible ring into the vagina, which releases a steady stream of estrogen directly to the vaginal tissues. You replace the ring every three months as long as you need it. My patients also love the vaginal estrogen tablet. You use a disposable applicator to insert a tablet into your vagina once a day for the first two weeks of treatment. Then you insert it twice a week until you no longer need it. The least expensive option is vaginal estrogen cream. You use an applicator to insert the cream into your vagina, usually twice a week. It's a little messy, but it has one advantage over the other choices: You can dab some on the outside tissues of the vagina to reduce irritation. Many women will get the cream for this reason, as well as use the tablets or ring. (Note that this dosage will not help symptoms such as hot flashes.)
LHJ: Do you need a prescription?
LS: Yes, but there's a non-prescription option for women who, despite their safety record, are wary about using a hormone. One over-the-counter vaginal moisturizer that I recommend to my patients is Replens, which adds moisture to cells, plumping them up and reducing dryness. Although they don't advertise it, these products also help normalize pH, fixing the foul odor and discharge. You generally need to use them twice a week, although you may find you need them less over time as your pH becomes better balanced.
LHJ: Will these remedies resolve issues with painful sex too?
LS: They'll help with wetness, but many women find using a lubricant, too, really makes sex more comfortable. There are two types of lubes: water-based and silicone-based. The water-based ones tend to be gloppy, sticky and don't last very long. And, unfortunately, they're what you're most likely to find at your local drugstore. Silicone-based lubes are much better -- they're less sticky and provide much longer-lasting slipperiness. They cost a little more and you may have to get them online. But if you search "silicone lubricant," at places like drugstore.com you'll find there's a wide range of choices.