Vaginal problems: treatments
Lack of estrogen can cause dryness and thinning of the vaginal tissues making intercourse uncomfortable or even painful. The first sign of an effect of reduced estrogen on the vagina is reduced lubrication during sexual activity. HRT can alleviate this but even if you cannot take systemic HRT you may still be able to use estrogen topically to the vagina. For some women, vaginal estrogen may be needed in addition to HRT. Vaginal estrogen is available in a few forms; creams administered via applicators, small tablets inserted with an applicator or a vaginal ring which stays in place for 3 months at a time. For creams or vaginal tablets, the initial dose is 1 application nightly for 2 weeks, followed by the maintenance dose of 1 application twice weekly. Low dose vaginal estrogen preparations can be used long term without causing any known systemic effect, and without needing any progestogenic protection of the lining of the womb.
Even if you cannot or do not want to use hormones there are other options. Over the counter bio-adhesive vaginal moisturisers are very effective. A range of products are available, many of which are easier to use than KY jelly, which is water based and more slippery. These moisturizers are also slightly acidic which helps prevent vaginal infections. One other advantage is that they do not need to be used at the time of intercourse. Several non-hormonal vaginal products can be also be prescribed and include Replens MD, Yes, Hyalofemme and Sylk.
News Item: See this news item on confusion about vaginal estrogen
Please note: Patients should consult a health professional to decide on the appropriate treatment option to be prescribed.
Local estrogen can be used for vaginal and bladder symptoms, when systemic treatment is not desired or appropriate. For some women, vaginal estrogen may be required along with systemic HRT.
|Gynest - Estriol - 0.01% cream.||£4.67 per 80g|
|Ovestin - Estriol - 0.1% cream||£4.45 per 15g|
ESTROGEN VAGINAL TABLET
|Vagifem 10--Estradiol 10mcg||£16.72 for 24 applicators|
|ESTROGEN VAGINAL RING|
|Estring--Estradiol --3 month's treatment||£10.97--£31.42 per ring|
|ESTROGEN VAGINAL PESSARY|
|Imvaggis-Estriol 0.03mg||Price tbc|
|ESTROGEN VAGINAL GEL|
|Blissel -- Estriol50 micrograms/g vaginal gel||Price tbc|
|Senshio - Ospemifene 60mg daily||£39.50 for 28 tablets|
|NON HORMONAL VAGINAL TREATMENTS WHICH CAN BE PRESCRIBED|
|Hyalofemme||£4.60 for 30g tube with reusable applicator|
|Regelle||3 dose pack (9 day supply) £3.29
6 dose pack (18 day supply) £5.41
12 dose pack (36 day supply) £8.32
£6.01 for 6 dose pack£6.01 for 35g pack
(up to 12 applications) + applicator
|Sylk||£5.16 for 40gms, sufficient for 75 to 100 applications|
|Yes||Yes water based in 5ml applicators. 6 pre-filled applicators. Price: tbc|
|Yes||Yes water based in 75ml single tube. Dose: 1 application intravaginally every 2-3 days. Price: tbc|
- Estrogen creams and tablets - initial dose is nightly for 2 weeks, followed by twice weekly applications for maintenance.
- Estrogen pessary and gel --nightly for 3 weeks then twice weekly.
- Vaginal ring should be replaced every 3 months.
- Replens – 1 application 3 times weekly in the morning.
- Sylk - use as required.
- Hyalofemme - once every 3 days.
Laser treatment applied to the vaginal wall is believed to increase vascularity and lead to rejuvenation of vaginal tissues. Limited data is available on effect and safety but preliminary data is encouraging. This treatment is not yet available in NHS clinics.
Download a checklist of vaginal atrophy symptoms you can print out and take to your GP or nurse to help you start a discussion: PDF (47K) or Word (47k)