Hormone Pharmacist

Hormones: Clear and Simple

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Dyspareunia Part 3 DHEA for Vaginal Menopause Symptoms

Dyspareunia Part 3 DHEA for Vaginal Menopause Symptoms


Are you struggling with menopause symptoms like vaginal dryness, itching,  irritation and even painful intimacy?  

If so, you’re not alone.  About 40 to 60% of menopausal women in a recent study complained of vaginal issues that make intimacy difficult or even painful.

As I mentioned in my last post,  the hormone estriol has been used for years in Europe, to help relieve vaginal atrophy caused by the loss of hormones at menopause.

Canadian endocrinology researcher, Dr. Fernand LaBrie, is conducting clinical trials using DHEA in menopausal women with vaginal atrophy. [1. Labrie F, Archer DF, Koltun W, Vachon A, Young D, Frenette L, Portman D, Montesino M, Côté I, Parent J, Lavoie L, Beauregard A, Martel C, Vaillancourt M, Balser J, Moyneur É; members of the VVA Prasterone Research Group. Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause. Menopause. 2015 Dec 28.]

DHEA is a hormone that’s converted within the tissues into estrogen or testosterone when they’re needed.  Dr. La Brie has published groundbreaking research in “Intracrinology,” this study of how hormones work within the cells. His research shows that DHEA, when given as a vaginal suppository, dramatically improves vaginal health, reduces painful intimacy and helps vaginal lubrication.

Women receiving vaginal DHEA showed no increases in the levels of DHEA or other sex hormones in their overall circulation. [2. Ke Y, Labrie F, Gonthier R, Simard JN, Bergeron D, Martel C, Vaillancourt M, Montesino M, Lavoie L, Archer DF, Balser J, Moyneur E; other participating Members of the Prasterone Clinical Research Group. Serum levels of sex steroids and metabolites following 12 weeks of intravaginal 0.50% DHEA administration. J Steroid Biochem Mol Biol. 2015 Nov;154:186-96. doi: 10.1016/j.jsbmb.2015.08.016. Epub 2015 Aug 17.]

Patients enrolled in the trials reported very mild, infrequent side effects. [3. Labrie F, Derogatis L, Archer DF, Koltun W, Vachon A, Young D, Frenette L, Portman D, Montesino M, Côté I, Parent J, Lavoie L, Beauregard A, Martel C, Vaillancourt M, Balser J, Moyneur É; Members of the VVA Prasterone Research Group. Effect of Intravaginal Prasterone on Sexual Dysfunction in Postmenopausal Women with Vulvovaginal Atrophy. J Sex Med. 2015 Dec;12(12):2401-12. doi: 10.1111/jsm.13045. Epub 2015 Nov 23.][4. Labrie F, Montesino M, Archer DF, Lavoie L, Beauregard A, Côté I, Martel C, Vaillancourt M, Balser J, Moyneur E; other participating Members of the Prasterone Clinical Research Group. Influence of treatment of vulvovaginal atrophy with intravaginal prasterone on the male partner. Climacteric. 2015 Dec;18(6):817-25. doi: 10.3109/13697137.2015.1077508. Epub 2015 Oct 30.]

DHEA is in Phase 3 Clinical Trials, which means the drug manufacturer is hoping to have a vaginal DHEA product on the U.S. Market in the next couple of years, pending FDA approval. DHEA is currently classified as a nutritional supplement by the FDA. It can also be compounded by a specialized pharmacy into a vaginal suppository or a cream.

Talk with your doctor to see if you might be a candidate to try DHEA for your vaginal menopause symptoms and you’ll also receive a report I’ve written about what I think is the best combination therapy for menopause.

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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.