Treatment
Vaginal atrophy can be treated with estrogen therapy. The doctor may prescribe an estrogen pill, a topical estrogen cream, suppositories to insert in the vagina, an estrogen skin patch or a vaginal estrogen ring. Estrogen cream or suppositories are inserted into the vagina using an applicator. An estrogen patch is applied once or twice a week to deliver estrogen through the skin. A vaginal ring is placed in the vagina for 3 months and slowly releases estrogen directly to the vaginal tissues. Women also may use water-soluble lubricants for comfort. Water-soluble lubricants do not contain estrogen and can be purchased without prescription at drug stores, pharmacies or grocery stores.
Until recently, estrogen had been thought to reduce the incidence of heart attack and stroke in postmenopausal women, but recent clinical trials, known as the Women's Health Initiative, have thrown doubt on that theory. This research shows that women actually may be more at risk of heart attack and stroke while using combined estrogen-progesterone therapy and at higher risk of stroke when using estrogen alone. Based on this study, the use of estrogen, in combination with progesterone or alone, is no longer recommended for the prevention of heart disease or stroke. However, estrogen is still recommended for the temporary relief of symptoms associated with menopause, such as vaginal atrophy. Doctors will try to use the lowest dose possible to relieve symptoms. Use of vaginal estrogen preparations causes very low levels of estrogen in the blood and thus is the safest way to treat vaginal atrophy with estrogen.
Women who still have a uterus and use estrogens should be aware that they can experience bleeding, which can be similar to a regular menstrual cycle. You should talk with your doctor about any bleeding you experience.
Women who have the following problems should not take estrogen:
Unexplained vaginal bleeding
Chronic or active liver disease
Breast cancer
Endometrial cancer
Recent blood clots or a history of blood clots
In addition, women with migraine headaches, gallbladder disease, high blood pressure or endometriosis may not be candidates for estrogen therapy. If you have these problems, you should discuss the issue with your doctor.
Women who cannot use estrogen may use a water-soluble vaginal lubricant as needed to relieve vaginal dryness and moisten tissue.
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