Conventional hormone replacement therapy (HRT)—estrogen combined with a synthetic version of the hormone progesterone—can be used to treat the vaginal dryness and thinning associated with low estrogen during menopause. However, recent studies indicate that the risks associated with the long-term use of HRT may outweigh any benefits. As a result, HRT is now only recommended for short-term use to treat severe menopausal symptoms for which other remedies are not effective.
A safer alternative for vaginal dryness is a form of estrogen hormone therapy that is delivered directly to the vagina. This can help relieve vaginal dryness, irritation and pain, without the risks of HRT. A vaginal estradiol ring, which can be placed in the vagina for 90 days at a time, is now available and delivers low-dose estrogen locally. Another local vaginal delivery system is a tablet that you insert into your vagina daily for two weeks, followed by twice a week thereafter. These two options are safe and effective, and deliver a time-released, low dosage of estrogen directly to the vagina. Topical estrogen cream, although effective, is not a controlled delivery method, making it possible to achieve high blood levels of estrogen from the absorption in the vagina.
Non-hormonal options that may improve vaginal dryness include vaginal moisturizers and lubricants. These are available over-the-counter, and can be used either on a daily basis or with sexual activity. Using them regularly can improve vaginal dryness and the discomfort it can cause during sexual activity.