Why You Need Vaginal Estrogen
This is a typical scene in my office:
Me: Would you be interested in vaginal estrogen cream to help with the vaginal dryness?
Patient: Oh no, that part of my life is over. It doesn’t bother me that much anyway.
Now some people will never need vaginal estrogen cream, while many absolutely do, and many others minimize their symptoms as normal, just a part of the change, or just something we have to deal with as women.
As estrogen decreases through perimenopause and menopause, it can create vaginal dryness, atrophy, and irritation. But if we add estrogen back to the vaginal tissue in a timely manner, we can repair or minimize these issues. Even if you are not sexually active, vaginal estrogen can greatly improve your quality of life, and let me tell you why.
More Comfortable Exams
If exams always lead to you gritting your teeth, tensing every muscle in your body, and holding your breath until the sharp burning pain is over. . . vaginal estrogen cream can help. Atrophy of the vaginal tissue makes it difficult to tolerate a speculum exam. Sometimes with difficult cases of atrophy, patients cannot tolerate a speculum exam at all, which could lead to decreased cervical cancer screening, and later detection of cervical cancer.
More Comfortable and More Enjoyable Sex
If you are sexually active, but now sex is painful, you dread it, and do almost anything to avoid it, vaginal estrogen cream can help. Atrophic vaginal walls are less elastic and do not lubricate easily on their own. With the use of vaginal estrogen, we can add back elasticity and lubrication to the vaginal walls. Vaginal estrogen cream will not replace the need for good communication, necessary foreplay, and additional lubricant at the vaginal opening, but it can make sex enjoyable instead of painful.
Fewer Vaginal Infections and UTIs
As estrogen decreases, the good bacteria that maintain a normal pH balance in the urogenital flora have a harder time. They thrive in an environment with estrogen, and without them, it’s easy for bad bacteria to overgrow. Some signs you may benefit from vaginal estrogen are: recurrent yeast or bacterial infections, recurrent UTIs, and especially recurrent UTIs after intercourse.
Decreased Discomfort with Exercise/Daily Tasks/Life
I have had patients who had to stop riding their bikes, running, etc., because of the discomfort of vaginal dryness. I have even had patients tell me that it is difficult to find a comfortable way to sit when the dryness gets bad. These experiences are not normal and are not an expected part of aging. If your life and the things that bring you joy are now a cause of pain, you may benefit from vaginal estrogen.
A Few Final Thoughts
Vaginal estrogen is not for everyone. If you prefer a non-hormonal option, there are many vaginal moisturizers over the counter, and other products like Revaree and Intrarosa.
Vaginal estrogen is typically well covered by insurance, but if it was too expensive with your insurance coverage, make sure to ask your provider about sending it to a different pharmacy. I have had good luck with Cost Plus in the past (and they don’t pay me to say that).
Lastly, vaginal estrogen does not necessarily have to be used forever. Many patients will taper off over time, while others will use it for years and years. That’s why it is important to be seen by your healthcare provider yearly, so we can evaluate if this is still the right option for you.
So remember that you deserve to feel comfortable and confident in your everyday life. And if you are experiencing negative symptoms of perimenopause and menopause, it doesn’t have to be your normal. You deserve more.
