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Menopause Through The Eyes of a Gynecologist- Vaginal Dryness

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In 2010 there were 46 million women between the ages of 50-80 years old.  Approximately 40 % of these women are having problems with vaginal dryness, burning, “post menopausal slime” and/or painful intercourse.  We have multiple treatment options for this condition if you do not have any risk factors for breast cancer.  However, if you are a breast cancer survivor or have a strong family history of breast cancer your options are extremely limited.  I have advised these women for years to use vegetable oil daily.  For a few this has been helpful but for most it has not been successful.  I understand that Dr. Oz in one show recommended Olive Oil.  I personally can tell you that Olive Oil is to thick and sticky!  The FDA has recently cleared a new treatment modality for these patients called the Mona Lisa Touch.  This is a vaginal CO2 laser that is an in-office procedure, requires no anesthesia, takes less that 5 minutes to perform and is highly successful.  It requires 3 treatments spaced 6 weeks apart. I’m sure everyone will say “Sign Me Up!”  The downside is that it is not covered by insurance so the out of pocket cost is about $1800.00 for the 3 sessions.  Visit www.VaginalHealth.com

If your only symptom of Menopause is vaginal dryness and you have no contraindications to Estrogen then there are several options.  In the cream category there is Estrace Cream ( remember this is Bio-Identical) and Premarin Cream.  I have had more patients react to Estrace  Cream because they are allergic to the perfume in it.  Both are covered by insurance but still a little pricey.  Both have prescription cards to make them less expensive.  Premarin has a study out that it can be used twice a week in patients with a uterus and not have any effect on the uterine lining. Premarin is obtained from pregnant horse urine.   Most patients feel these are messy.  Vagifem is a pellet (Bio-Identical) of estrogen that is placed in the vagina with an applicator 2 times a week.  It does not increase the uterine lining so you don’t have to take a progesterone with it.  Most insurances cover these at a second or third tier rate.  Some doctors will prescribe you oral estrogen tablets to place in the vagina.  This is an off label use and whether this increases your chance of uterine cancer has not been studied.  Another option that I use a lot is the E-string.  This is a thin plastic ring of Estrogen that you place in the Vagina and it stays for 3 months.  Some women take it out for intercourse although you don’t have to and it is third tier on most insurance.  It does not increase the Uterine lining.  The new one on the block is Osphena.  This is a once a day oral pill that selectively treats the vagina with estrogen.  It does not have an estrogen effect on your uterus or breasts.  You cannot use it if you have had breast cancer and most insurance covers it at the highest rate.

Most Menopausal Women have more symptoms than just vaginal dryness so I will address these treatment options in future posts.