As levels of the hormone estrogen decline with menopause, a number of uncomfortable and painful symptoms can develop. One of the most painful symptoms of menopause is vaginal dryness and atrophy. Vaginal symptoms of hormone decline can cause sex to be painful, make infections more frequent, and cause urinary problems. Over 50% of menopausal women will experience vaginal atrophy and many of them do not seek help. Symptoms like hot flashes and night sweats may go away for many women after menopause. Vulvovaginal symptoms of hormone decline however tend to increase with age even as other symptoms lessen.

Estrogen and Vaginal Health

Estrogen helps maintain vaginal health and lubrication. When there is less estrogen in genital tissues it can lead to vaginal atrophy, which is when vaginal tissue becomes weak, thin, and less elastic. This weakening can cause itching, irritation, and frequent infections. Decreased estrogen levels lead to a change in pH balance that can contribute to susceptibility to infections. In addition to maintaining vaginal health, estrogen also is responsible for stimulating the production of lubrication during sex. When vaginal dryness, irritation, and decreased elasticity from atrophy are combined it can cause sex to be painful. For many women the first course of action is to use an over-the-counter product to improve lubrication.

Solutions for Vaginal Symptoms of Menopause

Non-prescription solutions to vaginal dryness include lotions and creams that can provide temporary relief – usually for a few hours. There are both moisturizers and lubricants that can be used to make sex less painful. A lubricant applied immediately before sex can help with dryness and reduce pain. A moisturizer can be applied regularly to gradually improve dryness. While these can both provide relief they do not treat the cause of vaginal symptoms, which is the decreased level of estrogen. Hormone replacement therapy can be the most effective, long-term solution for menopausal women who are experiencing vaginal atrophy and dryness.

Hormone Replacement Therapy

Replacing the estrogen that was lost with menopause can restore vaginal health, improve pH to reduce the chance of infection, and increase lubrication. Topically applied estrogen is a commonly used method for improving estrogen levels in the vagina. There are multiple products available in different forms that usually contain the estrogen hormone estradiol (E2).  A cream or suppository from a compounding pharmacy and can be made in multiple dosages based on each woman’s needs.

When taking estrogen replacement, it is usually recommended that a woman also take progesterone to prevent estrogen dominance. High levels of estrogen that are not balanced with progesterone can lead to negative side effects and health complications. However for the low doses required when estrogen is applied vaginally, the use of progesterone is not usually necessary. In most cases, the potential side effects of taking oral estrogen are lessened or avoided with vaginal application. A doctor will most often prescribe the lowest dose and move upward while monitoring if a patient’s symptoms are improving.

Hormonal Balance and Compounding

Hormones are all connected to one another and achieving the right balance of hormones is as important as increasing levels of estrogen. Hormones and supplements are often combined as part of hormone replacement therapy including testosterone, DHEA, and pregnenolone. Combining multiple ingredients into one medication customized for an individual patient is a compounding pharmacy’s specialty. Estrogen, progesterone, and testosterone are often combined into one cream, capsule, or suppository in amounts determined by a woman’s unique hormonal makeup and needs.