HORMONES FOR UROGENITAL SYMPTOMS

There are several options to treat vaginal and bladder symptoms. There are over the counter products, prescription medications and mechanical treatment options.

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Over the counter products include moisturizers and lubricants. Moisturizers are vaginal cream/gels that are used as needed for comfort and are not related to sexual activity. Lubricants are vaginal gels that are used with sexual activity.

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The prescription medications include vaginal estrogen tablets (used 2x/week), vaginal estrogen creams (used 2x/week), a vaginal estrogen ring (changed every 3 months), a vaginal DHEA cream (used nightly) and an oral SERM (selective estrogen receptor modulator) tablet (taken daily).

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The symptoms are often greatly improved after 6 weeks of using one of these medications. You need to continue to use the medication to prevent the recurrence of the symptoms. Using a vaginal estrogen or DHEA is not hormone replacement therapy as the dose of medication used is very small and only small amounts get into the bloodstream. It would not help with other symptoms like hot flashes but also has fewer risk than whole-body hormone replacement therapy.

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Mechanical options increase blood supply to the vulvovaginal tissue. Sexual activity (with or without a partner) helps maintain healthy vaginal tissue and decreases vaginal dryness. Vaginal dilators and pelvic floor physical therapy can also be helpful for some women. There are also various vaginal laser procedures that are undergoing evaluation currently for treatment of vaginal atrophy. These may be particularly useful for women who cannot use the vaginal estrogens or DHEA, such as women with breast cancer.

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Available data suggest that inducing changes in vaginal tissue with laser intervention can treat the symptoms of vaginal dryness. Laser therapies are not yet FDA approved as they currently lack long-term safety and efficacy data but they may be considered in women who prefer non-hormone treatments after a discussion of potential risks, benefits, potential need for ongoing treatments and cost. 

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