There are an estimated 64 million menopausal women in the US, and around 1 in 2 women will experience symptoms of vulvovaginal atrophy (VVA). This is due to a decline in estrogen and testosterone production from the ovaries and unlike hot flashes, the effects to the vulva and vagina will only get worse if left untreated. The term “vaginal atrophy” has a negative connotation and most women do not like to hear their vagina has atrophied. To address this concern and better describe the constellation of symptoms a woman may experience during menopause, ISSWSH and NAMS (2016) developed the term genitourinary syndrome of menopause (GSM).

Symptoms of GSM

  • Vaginal dryness
  • Painful sex
  • Lack of lubrication
  • Recurrent UTIs
  • Recurrent vaginal infections
  • Urinary urgency/frequency
  • Burning with urination
  • Leakage of urine


Lubricants/Vaginal Moisturizers

These products can be purchased online or over the counter without a prescription. Although they are considered first-line therapy, they do not treat the underlying cause which is a decline in estrogen and androgen levels from the ovaries, which occurs with natural aging or surgical removal of the ovaries.

Recommended Products Include:

Local Vaginal Estrogen

There are several FDA approved treatments in the form of a cream, tablet, ring, or soft-gel vaginal insert. Note: conjugated estrogen is a synthetic hormone and estradiol is a bioidentical hormone. We can help you choose a treatment that is best for you.

Vaginal Hormone Treatment Options

  • Premarin (conjugated estrogen vaginal cream)
  • Estrace (estradiol vaginal cream)
  • Yuvafem or Vagifem (estradiol vaginal insert)
  • Estring (estradiol vaginal ring)
  • Imvexxy (estradiol soft-gel vaginal insert)

Non-Hormonal FDA Approved Treatments

This includes Intrarosa (prasterone) which is an intravaginal DHEA suppository and Osphena (ospemifene), an estrogen agonist/antagonist oral pill.

We will discuss the risk/benefits/side effects to all treatment options so you can decide which one is best for you.

Please Note: Many clinical trials have confirmed that vaginal estrogen and vaginal pratsterone (DHEA) do not raise estrogen above levels that would normally be seen in postmenopausal women. However, all FDA approved estrogen products from oral pills to transdermal preparations to vaginal creams, rings, and inserts have the same boxed warning. This is a class warning, but local vaginal estrogen has not been associated with an increased risk for breast cancer, endometrial cancer, a cardiovascular event, or dementia. This is confusing for many patients and menopausal experts have worked hard in attempts to change this labeling as it is confusing for many women considering treatment options.