Why Use Vaginal Estrogen And What You Should Know
Why would a woman want to use vaginal estrogen? And why would a doctor like me, Dr. Pam, prescribe it? We are so scared of the word “estrogen.” There are 2 types of estrogen replacement therapy. One is systemic which goes through your whole body, and one is vaginal. Right now, I would just like to talk about vaginal estrogen therapy. When women hear the word estrogen, they usually think of the side-effects which are breast cancer and blood clots. But, vaginal estrogen does not have these effects.
Unfortunately, the FDA has put these black box warnings on vaginal estrogen and it is really unwarranted. There is no evidence that vaginal estrogen causes blood clots or breast cancer. In fact, there are lots of OB/GYNs who are using vaginal estrogen in breast cancer patients under the right circumstances. After menopause, you are not making estrogen anymore, so when we can give it back to you, this is “estrogen replacement therapy.”
Vaginal estrogen replacement therapy just works in the pelvis. And it attaches to all of those vaginal estrogen receptors, bladder estrogen receptors, in the urethra, and around the rectum and all the tissue that is the connective tissue that combines this. It keeps it all stronger, and thicker, and well lubricated which is what we want. Remember ladies, the only place that we want wrinkles is in our vagina. There are lots of folds or wrinkles in the vagina – it works like an accordion and it stretches out, but after the estrogen is gone and there is nothing attached to these estrogen receptors, the vagina becomes a straight, non-compliant tube which is why it hurts to have intercourse.
There are three different ways to give vaginal estrogen and to give vaginal estrogen to those receptors. One is a cream. What we are talking about is using one to two grams twice a week and this has been designed to stick to the walls of your vagina so it stays there. The second option is to use a vaginal pill. It is a tiny little tablet in a blue applicator. It is called “Vagifem®.” There is only one brand in the United States available. And what you do, it looks like it’s on a little applicator like a Bic pen and you put it into her vagina and just click it in there. I have my patients do this every other day and the pill melts over 24 to 48 hours and gives local estrogen to the vagina. The third way is a vaginal ring. It is a silastic ring and it is impregnated with estradiol. You put the ring in there and push it up as far as you can.
For those of us who used a diaphragm many years ago, you put it in the exact same way. You push it up as far as you can and then you take your finger and then try to push it on top of your pubic bone.This ring gives off estradiol for three months. Once the package is opened, it is heat activated in your vagina,and it will last for 3 months. You can take it out every day and rinse it off if you want. You can leave it in for intercourse or you can take it out. Whichever is more comfortable for you. There is a new option for vaginal dryness that you do not insert into your vagina. There is a new drug called Osphena®; the generic name is called ospemifene. It is the first and only FDA-approved non-estrogen oral treatment that reverses the physical changes of the vagina and relieves some of the moderate to severe pain with intercourse that is due to menopause.
If you don’t use anything for 10 years or 15 years and then you want to get your vagina back in shape to have intercourse, it may take months or even years to get it back to where it was to where it is comfortable to have intercourse again. I want you to never let it get in that bad a shape. I want you to keep it perfect for the rest of your life. I want you to start at age 50, use the vaginal estrogen regularly, and keep the vagina think and spongy and well-lubricated and keep those folds. If you have any questions about the use of vaginal estrogen, please give me a call or contact me through the website.