Hormone Pharmacist

Hormones: Clear and Simple

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Dyspareunia Part 2 Estriol for Vaginal Menopause Symptoms

Dyspareunia Part 2 Estriol for Vaginal Menopause Symptoms

Are you struggling with vaginal dryness, irritation and maybe even painful intimacy?

Menopause causes changes in vaginal tissue that make intimacy uncomfortable. One study showed 44% of menopausal women saying intimacy was painful, that’s called dyspareunia. Even women who weren’t sexually active complained of vaginal dryness, itching and irritation after menopause.

Last Thursday, one of my patents complained of what she bluntly called, “. . . the Sahara Desert between my legs.”  Not coincidentally, I was counseling that patient about her prescription for estriol to treat vaginal atrophy.  The fact that no one talks about it doesn’t make it less of an issue.

In my last post, I went over some FDA approved estradiol products that reverse vaginal menopause symptoms. Another option, vaginal Estriol, also called E3, is available in the U.S. from compounding pharmacies.

Estriol is one of the weakest bio-identical estrogens, exactly the same as an estrogen your body makes. Estriol has been prescribed as Ovestin® oral tablets or vaginal cream to treat vaginal menopause symptoms in Europe, Australia and the U.K. For over 20 years.

In the U.S., a compounding pharmacist can make up estriol prescribed by your doctor in a vaginal suppository, troche or cream. Because it’s not FDA approved, estriol is covered by only a few insurance companies. You’ll pay around $50 to $70 for a vaginal estriol prescription, but that’s at least $100 less than most of the commercially available vaginal products.

Estriol cream or suppositories are inserted vaginally once a day at bedtime, every night for a couple of weeks. After that, the dose is cut back to 2-3 times weekly. This regimen helps to build up vaginal tissue and reverse vaginal atrophy. Less frequent estriol doses help maintain that healthy vaginal tissue.

Since Estriol is a weaker estrogen, it’s not used as often by itself for hot flashes, but it can really help with vaginal issues. Talk with your doctor about the possibility of getting a prescription for estriol from a specialty compounding pharmacy.

There are some promising clinical trials going on with vaginal DHEA that I’ll tell you about in my next video, Part 3 in this series on treatment of vaginal menopause symptoms. To stay informed about when I upload new videos, subscribe to my channel on YouTube.

Join me for hormone updates. I have lots more useful, practical information about the best treatments for all your menopause symptoms.

Thanks for watching and I’ll talk with you again soon.

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Dyspareunia Part 1 Treatment of Vaginal Menopause Symptoms

Dyspareunia Part 1 Treatment of Vaginal Menopause Symptoms

Some women in menopause experience something called vaginal atrophy.  This can lead to intimacy issues that might have a negative impact on your relationship.

Of course, the first thing you need is understanding and patience from your partner with the changes in your body during menopause, but there are treatments that can reduce vaginal symptoms.  Over the next few videos, I’ll explain some of these treatments

The decreases in estrogen and testosterone that your body experiences at menopause cause the layers that make up the vaginal wall to change dramatically.

In a recent survey of 3000 post-menopausal women [1.Wysocki S, Kingsberg S, Krychman M. Management of Vaginal Atrophy: Implications from the REVIVE Survey. Clinical Medicine Insights Reproductive Health. 2014;8:23-30. doi:10.4137/CMRH.S14498.]
• 55% said they had vaginal dryness
• 44% reported dyspareunia – painful intimacy
• 37% complained of vaginal irritation
• 60% said these symptoms affected their enjoyment of sex

The REVIVE survey showed these women were hesitant to talk with their doctors about these issues.

There are effective treatments for vaginal dryness and painful intimacy.  You don’t have to just “Get used to it.”

Over the counter lubricants may help with mild vaginal dryness, although about 40% of the women surveyed said that Replens®, K-Y® and Astroglide® had not worked for them.

Hormone replacement products can reverse menopausal vaginal atrophy.

Estrace® vaginal cream, Estring® vaginal ring and Vagifem® vaginal tablets all  contain estradiol, exactly the same as an estrogen your body used to make.  Estradiol is very effective at restoring vaginal health and reducing vaginal menopause symptoms. [2.Mac Bride MB, Rhodes DJ, Shuster LT. Vulvovaginal Atrophy. Mayo Clinic Proceedings. 2010;85(1):87-94. doi:10.4065/mcp.2009.0413.]  Cash prices for commercially available estradiol products for vaginal atrophy range from $175 to $375. [3. Estrace® pricing information from goodrx.com] [4. Estring® pricing information from goodrx.com] [5. Vagifem® pricing information from goodrx.com]  They should be covered by insurance.

Avoid Premarin® vaginal cream because it has 10 or more horse estrogens you don’t need.

You may have seen ads for Osphena® featuring “Patti,” a woman in her 50s who is embarrassed but talks about painful sex after menopause.  Osphena® is an estrogen blocker that also helps reduce vaginal dryness.  A downside of Osphena® is that it can cause hot flashes.  The cash price of Osphena® is around $180 for 30 oral tablets. [6. Osphena® pricing information from goodrx.com]

Two more options for vaginal symptoms are only available in the U.S. from a compounding pharmacy.  I’ll tell you about those in my next 2 video posts.  If you subscribe to my YouTube channel, you’ll be the first to know when I upload new videos.

Join me for hormone updates at hormonepharmacist.com, where I have lots more useful, practical information about the best treatments for all your menopause symptoms.

Thanks and I’ll talk with you again soon.  Watch for Part 2 of my series on Dyspareunia and its treatment with estriol.

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Menopause Symptoms – Night Sweats, Insomnia and Progesterone

Are you getting close to 50?
Having trouble sleeping?
Waking up soaked?
Having a hard time getting back to sleep?

If so, you may be experiencing your first symptoms of menopause.

Night sweats, insomnia and hot flashes during the day are caused by the drop in your estrogen and progesterone levels at menopause.

There are a lot of options out there that can be used to relieve your night sweats and insomnia.  But for women with the most severe night sweats who just can’t sleep through the night, Progesterone replacement is the key.[1. Eichling PS, Sahni J. Menopause related sleep disorders. J Clin Sleep Med. 2005 Jul 15;1(3):291-300. Review. PubMed PMID: 17566192.]

Progesterone isn’t the same as progestins, powerful synthetic hormones that work LIKE progesterone, but don’t even come close to replacing the progesterone your body needs.

Here are some facts you need to know about progesterone:
1. Progesterone is sometimes called “bio-identical progesterone,” which means it’s chemically exactly the same as the hormone your body makes (or at least used to make)
2. Progesterone helps menopausal women have fewer night sweats, sleep better and even have fewer hot flashes during the day.
3. Progesterone has helped European menopausal women sleep for decades.  In a survey of 100 thousand French menopausal women,  the women who took Progesterone had lower breast cancer rates than women who took medroxyprogesterone, the most commonly prescribed progestin in the U.S..[2. Regidor P-A. Progesterone in Peri- and Postmenopause: A Review. Geburtshilfe und Frauenheilkunde. 2014;74(11):995-1002. doi:10.1055/s-0034-1383297.][3. Stanczyk FZ, Hapgood JP, Winer S, Mishell DR. Progestogens Used in Postmenopausal Hormone Therapy: Differences in Their Pharmacological Properties, Intracellular Actions, and Clinical Effects. Endocrine Reviews. 2013;34(2):171-208. doi:10.1210/er.2012-1008.][4. Fournier, A., Berrino, F., Riboli, E., Avenel, V. and Clavel-Chapelon, F. (2005), Breast cancer risk in relation to different types of hormone replacement therapy in the E3N-EPIC cohort. Int. J. Cancer, 114: 448–454. doi: 10.1002/ijc.20710][5. Fournier A, Fabre A, Mesrine S, Boutron-Ruault M-C, Berrino F, Clavel-Chapelon F. Use of different postmenopausal hormone therapies and risk of histology- and hormone receptor-defined invasive breast cancer. Journal of clinical oncology : official journal of the American Society of Clinical OncologyJournal of clinical oncology : official journal of the American Society of Clinical Oncology. 2008;26(8):1260-1268. doi:10.1200/JCO.2007.13.4338.]

Progesterone is readily available from any pharmacy in the U.S., as an FDA approved oil filled capsule for menopause symptoms. Progesterone is also available from compounding pharmacies in other dosage forms like sublingual troches and transdermal creams.

I’m here to help you understand the sometimes confusing world of hormones for menopause.  I’m constantly looking at the latest research on hormones and breaking it down so it’s easy to understand.

Thanks and I’ll catch you on my next post, which touches on intimacy issues in menopause.