I have talked to hundreds of women over the years regarding hormone replacement options and post-menopausal symptoms, as well as pre-menopausal symptoms that slowly start to become more noticeable. Vaginal dryness is one of the top and most bothersome symptoms for most women. Up to 45% of postmenopausal women may be affected, but it often remains underreported and undertreated.1 For some patients, it is so severe it causes extremely painful intercourse and, in some cases, even tearing or bleeding, which of course also impacts desire and libido.
Vaginal tissue is very dependent on estrogen. Vaginal atrophy is the thinning, drying, and inflammation of the vaginal walls, usually due to low estrogen. For many women, it also leads to urinary problems such as increased frequency, urgency, incontinence, painful urination, and infection. The lower urinary tract is directly affected by decreased estrogen, as estrogen receptors are found throughout the epithelial tissues of the urethra and bladder, and in some of the surrounding muscles and ligaments.1
Potential benefits of long-term therapy for vaginal atrophy include sustained relief of symptoms as well as physiological improvements (eg, decreased vaginal pH and increased blood flow, epithelial thickness, secretions). There are a few manufactured estradiol preparations available commercially for women for vaginal dryness. Multiple compounds are available for women that are frequently prescribed for vaginal atrophy, including estriol and DHEA.
Estriol is known as a weaker estrogen than estradiol, but studies have shown it to be an effective therapy even at a low dose to improve vaginal health and atrophy in postmenopausal women.2 The data also suggests that estriol preparations appear to be safe for women who have risk factors related to systemic estrogen therapy.3
DHEA is an androgen precursor that has demonstrated it can improve vaginal dryness as well as potentially libido. In a new prospective, randomized, double-blind clinical trial, Labrie et al confirmed the local beneficial effect of intravaginal DHEA (prasterone) on the symptoms of mild/severe dyspareunia, the most frequent manifestation of genitourinary syndrome in postmenopausal women..4 In addition, through local action in the vagina, DHEA applied vaginally daily has shown potent beneficial effects on sexual dysfunction including desire/interest, arousal, orgasm, and pain at sexual activity..5
Genesis Pharmacy offers several different dosage form options for vaginal administration, including suppositories, creams, and tablets. Every prescription is customized and can also be suited for patients with allergies or sensitivities, such as by using a plain cocoa butter base for suppositories, or a clean cream base free of preservatives or ingredients that can potentially be irritating when used vaginally, such a propylene glycol that is in some manufactured vaginal products. These compounded options are also often a lot more cost-effective for patients when compared to commercial products.
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- Lindahl SH. Reviewing the options for local estrogen treatment of vaginal atrophy. Int J Womens Health.2014 Mar 13;6:307-12.
- Caruso S, Cianci S, Amore FF, Ventura B, Bambili E, Spadola S, Cianci A. Quality of life and sexual function of naturally postmenopausal women on an ultralow-concentration estriol vaginal gel. 2016 Jan;23(1):47-54.
- Rueda C, Osorio AM, Avellaneda AC, Pinzón CE, Restrepo OI. The efficacy and safety of estriol to treat vulvovaginal atrophy in postmenopausal women: a systematic literature review. Climacteric.2017 Aug;20(4):321-330. doi: 10.1080/13697137.2017.1329291. Epub 2017 Jun 16.
- Labrie F, Archer DF, Koltun W, et al. Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause. 2016;23(3):243–256.
- Labrie F, Archer D, Bouchard C, Fortier M, Cusan L, Gomez JL, Girard G, Baron M, Ayotte N, Moreau M, Dubé R, Côté I, Labrie C, Lavoie L, Berger L, Gilbert L, Martel C, Balser J. Effect of intravaginal dehydroepiandrosterone (Prasterone) on libido and sexual dysfunction in postmenopausal women. 2009 Sep-Oct;16(5):923-31.