It would be nice if lubricants always solved the problem, but sometimes the ravages of menopause make the vaginal walls so thin and dry, the only way to reverse the vaginal clock and make intercourse comfortable is estrogen. I know … estrogen. Everyone thinks breast cancer, blood clots, bad stuff. And if you weren’t thinking that, you will when you read the FDA-required package insert. Keep in mind the package insert is the same whether you are taking systemic estrogen pills or using a vaginal product. The dire warnings required by the FDA were based on data from the 2002 study of women taking oral estrogen and progesterone. None of the complications listed on the package insert have ever been shown to result from using vaginal estrogen.
When a woman uses vaginal estrogen, the amount of hormone that is absorbed into the bloodstream is miniscule, and even though it sounds counterintuitive, the longer you use it, the less estrogen gets absorbed. You read that right. But when you think about it, it makes sense. Dry, thin vaginal walls are like tissue paper, so when estrogen is first applied, it doesn’t stay in the vagina, it seeps right through.
Within a short time of starting therapy, the thin vaginal tissue thickens enough that the estrogen stays in the vagina instead of getting absorbed into the bloodstream. If you measure blood estrogen levels in a woman who routinely uses vaginal estrogen, her levels would be no higher than the normal post-menopausal range. That’s great news for the woman who is concerned about using estrogen or who has breast cancer. That’s also why there is no time limit on using vaginal estrogen. Women in their 80s can still enjoy intercourse. The real challenge is finding the partner who is still “good to go.”
Currently, there are three types of prescription vaginal estrogen products.
Estrogen cream (Estrace™ and Premarin™) has the advantage of giving both internal and external help, but tends to be on the messy side. The reusable applicator, while environmentally friendly, has to be washed, put away (where the kids won’t find it) and reused.
Vagifem™ is a pre-loaded estradiol tablet that avoids the messy factor, but has the disadvantage of only treating the vaginal walls.
The final vaginal estrogen product is Estring™, a silastic vaginal ring that you insert in the vagina and replace every 3 months. Kind of like your Brita.
For many women, the best way to go is with a combination approach. Use the ring or the tablet to get rid of the sandpaper-sex feeling, and apply cream on the outside a couple of times a week.
All vaginal estrogen products restore vaginal blood flow, decrease vaginal pH (making you less susceptible to infections), and improve the thickness, elasticity and lubrication of your tissue.
If lubricant isn’t doing it for you, don’t hesitate to talk to your doctor about vaginal estrogen – and soon you will be slipping and sliding again.