Q. I went through menopause several years ago and have struggled ever since with vaginal dryness and pain. A few years ago I used Premarin cream, but it was messy and smelly and I was scared that it might promote cancer.

Vitamin E soft gels as vaginal suppositories were not messy. They did help some, but the physician’s assistant at our clinic said I shouldn’t use vitamin E that way.

Replens helps slightly with the dryness but not with the pain. I’ve recently seen TV ads for a pill called Osphena that is supposed to treat this. What can you tell me about that option?

A. Osphena (ospemifene) was approved a year ago for postmenopausal women suffering from painful intercourse. Though it is not estrogen, vaginal tissues respond to it as if it were, becoming thicker and less fragile.

You might ask your doctor about trying these tablets for a short time. This drug might not be a long-term solution for you because uterine tissues respond to Osphena as if it were estrogen, increasing the risk for endometrial cancer. Women who have had a hysterectomy are not at risk of this problem and could use it without worrying. Any woman who develops vaginal bleeding while on Osphena should see her doctor promptly. Blood clots are another potential side effect.

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  1. El

    I am 53 and had a partial hysterectomy at 36. Several years ago, sex became unbearable due to vaginal dryness. Yes like sandpaper down there. I have been taking Osphena over a year now and can say I have a full sex life again. Still some dryness but not compared to before with the bleeding. We use coconut oil as lubricant. My only problem now is hotflashes which Osphena does not help. My dr is switching me to Premarin since I don’t have a uterus. He said it should help with both. We will see. Otherwise, I’ve had no problem that I’m aware of with the Ospena. If I remember I felt results in a couple of weeks. Hope this helps.

  2. Vanessa

    I tried vagifem 3 yrs ago successfully,along with evening primrose oil orally 3200mg coconut oil vaginally and stop using soap down there use lubrigyn hang in there it’s a journey you are not alone!!!

  3. Kim

    I am 53 and had a complete hysterectomy 8 years ago at 45. Only over the past 5 years has intercourse become painful. Almost like there is sandpaper wrapped around him ! He tries to understand that I just won’t even try anymore but I know it’s hard for him. Our children are all grown now and out of the house and these are the years we thought would be our best years for just us. Not so sexually. I do smoke, which I have tried to quit and have cut down but it’s just not working so as you know I have a big fear of medications and hormones. I don’t take meds well if at all. So I am looking for something that would be more natural that does not include hormones. Any helpful advise would be appreciated. Please no smoking comments. I already know it’s not good for me.

  4. Rene
    Dallas, TX

    All I can say is, WOW! I just got thru reading some of these comments and I don’t know what to think. I just took my first dose of Osphena today and am hoping it will help me. I was totally optimistic but now I am not so sure.

    I am 51 and for the last year or more I have been experiencing pain during sex, some vaginal bleeding and dryness as many of you. I am post menopausal and had very few symptoms during this time. Up until this started, my boyfriend and I have had an excellent sex life but now it is painful and just sad. I have read it could take three to four weeks to show any signs of improvement or to show any signs of problems, so my fingers are crossed.

  5. Kim

    I went thru menopause at the age of 47. I’m now 54 & still having menopausal symptoms. I was put on Estratest & Prometrium first, but felt bloated & got terrible yeast infections. I have used the natural progesterone cream with some success. I, too, have had the UTI issues which I’m convinced are related to the vaginal dryness. Last year my gyn put me on Prempro which helped a lot initally, but I also got a raging yeast infection from it. Then she put me on the Estradiol patch & prometrium……same problems with yeast infection after using it for a few weeks. I then tried Osphena. Seemed to help with the dryness, but I did notice problems with my sleep. I took it for 4 months & stopped because I had weird pains in my calves. I just don’t feel safe taking it, since it hasn’t been around for long. The thing that helped me the most so far, has been using Estrace cream. I haven’t tried the coconut or olive oil, so I may give that a shot, too.

  6. Kathy

    My doctor has advised me to have a laparoscopic hysterectomy. She says they have to cut my vagina to take out my uterus! Will I be able to have sex after this without pain? If anyone has had this surgery, I’d appreciate hearing about your experience. Thank you.

    • Kia
      Atlanta GA

      Yes you will be able to have sex. Your uterus is considerably smaller than a baby and a baby can fit through. It’s just less invasive than the old school way. I believe that means a shorter recovery period but, I’m not certain.

      • C C
        Reno, NV

        I had one two years ago. The recovery time is significantly less with this type of hysterectomy, I was back at work 5 days after. There is no external incision and I have had no pain from it with sex. In fact, I can’t tell at all where the incision was made.

        • Kathy

          Thank you, that’s encouraging! :)

  7. Diane

    I am almost 59 years old. Back in 2003, after having vaginal pain with intercourse, tampons, during exercise, my doctor discovered a neuroma (most people get them in their feet. Being the special/weird person that I am, got one in my vulva! lol) The neuroma was removed and I did pretty well with sex, just occasional discomfort due to the scar tissue.

    In 2007, I had a hysterectomy – uterus and both ovaries. From that point on, the pain started getting worse and worse. For the past 2 years, that area tears and bleeds during intercourse :( Not fun for either one of us so we just do without it. We should be having fun at this stage of our life!! Through these years I have had decadron injections (OUCH!!), physical therapy, dilation treatment – you name it, I tried it.

    Have been on Estrace cream for several years along with a compounded cream (my daughter is a pharmacist) that contains lidocaine, along with other things. Since last week, my gyn is having me use a steroid cream along with the other creams. She said to try intercourse after using it for a week so we did. Still hurt, still ripped, still bleed, and the stinging/burning lasted for 3 days afterward.

    I am not a happy camper and I am married to a saint! lol So tomorrow I’m seeing a CNP who treats women my age for hormonal issues, etc. I will be asking her about Osphena and whether I would be a good candidate for trying it. I’m curious to know if any of you have had that tearing and pain with spotting blood afterward and what you did for it. Kinda at my wit’s end on this :( I’ve been dealing with vaginal pain from one thing or another for almost 20 years and it sucks! Thanks for reading my story and also for giving me an outlet to discuss this with people who understand!! Thanks!!

  8. Gail

    Has anyone used osphena, how long till it works?

    • Sue
      United States

      Gail, I am your identical twin on all counts. I have gotten to the point that I am so depressed about it and have actually been grieving my womanhood. I also have a connective tissue disorders called Ehlers Danlos Syndrome which has left me with no elasticity and very thin skin tissue. I am 61 and feel like I’m 80. My husband too is a saint. Thinking of asking my doctor about Osphena too. My heart goes out to anyone who lives as we do:)

  9. Patty
    Tacoma, WA

    I went through menopause a very long time ago and never had any problems with sexual desire or intercourse. Not sure what my secret is, but I have noticed that foods, drinks, and supplements that promote circulation help a lot. I am careful with my diet. Rarely eat junk food, cut way back on carbs such as bread, cereals, pasta, etc. And I do consume dairy products. The fat in the dairy seems to help give me softer and more hydrated skin.

    Of course, if you are prone to gaining weight on dairy, that might be a side issue. I drink skim or 1% and eat full fat cheese. It did make me gain a few pounds, but my skin is more hydrated and softer. I kind of switch off and on with days of no cheese and days with cheese. I drink milk everyday and switch off and on with skim and low fat. I cut back on meat also. I drink beer off and on. I also get a moderate amount of exercise. No problems with being sexually aroused or orgasms. I also cut out coffee and only occasional sweets (I splurge on quality ice cream). I have an intolerance to soy; but the times I consumed it, I noticed it seemed to affect my hormones in that I felt more arousal and sometimes hot flashes.

    I hope some of this helps and that you might talk this over with your doctor.

  10. LindaS

    Ugh!! Been having a difficult time with dryness for almost a year or so. The GYN gave me a sample pack of osphena today. I’m 54, had a complete hysterectomy at 48, the doc put me on Premarin and a year later I had DCIS (duct all carcinoma in situ)…I believe it was caused by the estrogen…no breast cancer history in my family at all, so 9 months on Premarin & I had a very early stage breast cancer. That now leaves me with few options, since I am not even supposed to use natural estrogen products, in dealing with these new lovely side effects of aging…gracefully?? I’m trying this option, plus the coconut oil (thanks for the recommendationS everyone!), the hyaluronic acid, the natural bio-identical progesterone & lots of prayer. I’ve been married for 3 years…this is not good for a young marriage, but thankfully he’s rolling with it like me.

  11. martha

    first thank you to everyone who took the time to write. If anything you should feel better knowing you’re not alone in this new phase in your life. Personally, I crashed both mentally & physically & went straight into post-menopause (I know why but too long to share here) after 4 yrs of no sex (pain), all the creams, pills etc that didn’t help (said no to patch) my new dr referred me to a physiotherapist. She explains & does physical exercises that help stretch the opening of my vagina. Now on dilators. Has anyone else tried this? The tissue needs to be stretched but my vagina is now back to normal. Likely will take 6 mo to be able to have intercourse.

  12. Cheryl

    I just turned 50 in March and was thinking I would be 50 an fabulous but not the case Menapause started. I Had a hysterectomy about 8 years ago with one ovarie left but I guess it decided to quit on me. I started going to a doctor which said I wasn’t in Menapause and gave me estrace cream for vaginal dryness and vitamins I got worse got so nauseous that I couldn’t eat much, panic attacks, depression and couldn’t work so they said I was depressed and gave me nerve meds that made me sicker so I said screw all this I went back to my old dr, sat in his office having a hot flash and cried he said your in Menapause gave me Premarin pill which were great but did nothing for vaginal dryness. I’ve goole vaginal dryness and I started taking vitamin E, coconut oil pills, drinking soy milk and using estrace cream it’s not working yet. I use coconut oil before sex and it doesn’t hurt while doing it but the vagina isn’t to happy afterwards. I have started taking Ospena this weekend I’m hoping it will work because my problem is just hurting and burning thru out the day. Im praying that something will work because this pain at times has cause me not to do or go anywhere in fear that I would be in pain and not be able to enjoy anything. I didn’t know that all this vaginal dryness was possible because of Menapause. Good luck ladies I will be saying a prayer for all the ladies out there living thru all this. Say a prayer for me. thanks for sharing your stories I don’t feel alone now

  13. Dawn
    Colorado Springs, CO

    I had a complete hysterectomy when I was 25. I had endometriosis, severe bleeding and cysts everywhere. I was put on Premarin low dose and increased to 0.9mg .My insurance quit paying for it. Now I have painful intercourse and my boyfriend is having problems with believing I am making it up since I just been quiet and now it feels like sandpaper, knives all of the above I don’t know what works. Can someone please tell me. I saw the ad for ospreys but I don’t know what to do.

    • Kathy

      Have you talked to your gynecologist about the pain? If not, please do so. Also, the manufacturer of Premarin has a program that may help you pay for it. Check out this link: http://www.pfizerrxpathways.com/?step=1. I hope things get better for you.

  14. T

    For all those suffering with the pain, I use vagisel cream and a silicone lubrication. This helps from pain and dryness during sex

    • martha

      is vagisel & silicone lubrication avail at a drugstore over the counter or by prescription only?

  15. Sheri

    I had a terrible experience with Premarin Cream . The first month of use was wonderful but then it began to burn and itch me day and night. I believe it also caused me to develop intetsitial cystitis and vulvadinia. My doctor wad an idiot. It’s a long story but when I syoppef all attempts of estrogen therapy and stopped seeing the highly educated quack and used my own common sense, I gradually got better, I dtill have atrophy, but that is wrll handled compared to 24 hour pain, and sex doesn’t mean that much. Any way, if this new product mimics estrogen
    then you may as well be using estrogen. Don’t do it,

  16. Kathy

    I’m 64 and on the Climara patch and progesterone. This hasn’t helped the dryness and discomfort much at all. I had some bleeding and my doctor has increased the progesterone from 100 mg a day to 200 mg per day, and now I feel like I have to pee all the time! Has anyone experienced this with progesterone?

    Also, has anyone tried Chinese medicine for menopausal symptoms? Let me know if it has worked for you. Thank you.

  17. Triplets n 1

    I am a 50 y.o. woman who has Not gone through menopause just yet, but sex with my husband honestly feels like he has knives taped to him (is that an accurate description for anyone else?). In my mid-30s I underwent IVF & took LOTS of Estrogen & even more progesterone to maintain my pregnancies.

    My Gyn initially prescribed Clobetasol cream but it did absolutely nothing to ease the pain. Followed up with Premarin but admittedly I never tried it bc of all the scary side effects. Saw a commercial for Osphena & wonder if it could be the answer to my prayers…? I do have a history of cervical dysplasia & have uterine fibroids currently. But having such a terrible sex life is really taking a toll on my marriage and every time I just “grin & bear it” I end up totally torn to pieces for the next week-10 days.

    And due to 5 totally different sets of circumstances, I’ve gone through 5 gynecologists in the past 8-9 years (same office); this most recent one doesn’t seem to grasp the gravity of my situation, he wants me to try the Premarin & if that doesn’t work, have a hysterectomy, which I Really Don’t Want… :(. I’d love any feedback anyone might have. While I feel badly for each of the women who have posted in this forum, I take some comfort in knowing that it’s NOT just me having an isolated issue of unknown seriousness. So here’s to all of us suffering through this total BS condition; praying we all find some relief SOON!!!

    • Lee-Ann

      I am 50 years old, had a hysterectomy when I was 27 and have had some hotflashes now and then since 35, but the last year with them has been brutal. I have severe vaginal dryness which feels like he is wrapped in sandpaper and hurt for days after. If your doctor thinks a hysterectomy is the answer to your vaginal dryness, think again my dear. Like I said, had it when I was 27, and nope, the menopause symptoms are present and not seeming to ease off. I went to a Kinesiologist, he has taken away my hotflashes, now this week going to talk to him about the dryness and what I can do for it. If he leads me to something that will help, I will come back here and let you all know. Just wanted to tell you a hysterectomy is not the solution for vaginal dryness. Good luck in finding help. Please contact me by email if you wish.

      • Paula

        I had no idea that having sex could suddenly be as painful as the first time! My mom never warned me. (only about the first time, but not, one might say, “the last time”.) Jeez. She had a nasty smelling creme she used when I was an adolescent, her whole bedroom reeked of it. Does Premarin have a strong smell? It must’ve worked for her as she and my dad seemed to get it on with enjoyment. It sounded like it anyhow. *sigh* So no one recommends it? I thought a hysterectomy meant you lost all your hormonal functions, but I guess not. (like eunuchs could still have sex, I guess?)

    • Renee
      south carolina

      I’ve had frequent urinary tract infections, bladder issues, and painful sex since my hormones went whacko 4 years ago. I was 45. I loved sex with my hubby and suddenly it hurt. It wasn’t gradual. It hit like a freight train.

      My GP sent me to a urologist who told me, like my gyno, that I had a chronic bladder disease. My urologist has changed his mind about that. He now says I need to get on hormone therapy to fix my problems, which include a frequent urge to pee. My life is ruined at this point. I can’t travel. I can’t have sex. Any strenuous activity triggers painful urethral issues.

      I’m terrified of hormone therapy because of the risk of cancer. My aunt died from breast cancer. My cousin has had breast cancer twice. The last time ended in the removal of her breasts. And, no, “TRIPLETSN1”, it’s not just you. I’ve been using all sorts of natural supplements, trying to fix my problems. So far nothing has worked. I will be 50 at the end of this month and my sex life is non-existent.

      My drive is there but my nether regions are too painful. My mother is 73 and doesn’t have these issues. She never did. I’m so miserable. My poor hubby is very patient. I wish I could reward him for his patience without experiencing pain myself.

    • kath
      New York

      Ladies—-Having experienced at age 60 (I’m now almost 63) all of the symptoms mentioned below—–coconut oil. Yes coconut oil. If the oil is hard, take a q-tip and get a 1/2 a dime-sized little piece and insert. If the oil has liquified, use 2-3 q-tips held together, soak up some oil, and insert. Do this morning and before bed. Yes it can melt a little, but it’s certainly not worse than any of the @500 periods we all lived through !Takes about 6 weeks to see the difference but it made a big difference—-not perfect, but it really helps. I read this on another site for Osphena so I figured nothing to lose………….

    • Diane
      Hickory, NC

      Anyone who has pain and burning when urination should see their doctor, it could be a urinary tract infection.

  18. Adele S
    Orlando, Florida

    Sex hurts so much. The pain is so excruciating that it scares me. We always had a great sex life that came to a grinding halt. My gyn gave me a script for Osphena. I took it for three weeks and got bad stomach aches and diarrhea so I stopped taking it. I want to start again to see if it will help but worry about side effects.

    My partner is scared of hurting me and I feel broken. The Osphena comments on here go all the way from “miracle drug” to “dangerous drug.” I take Progesterone and use the Minivelle patch which, in my case, do nothing for vaginal atrophy. The Premarin cream did not help. This problem can destroy a relationship and, if it doesn’t, I feel horrible anyway. At least I now know I am not alone with this. What is the hyaluronic acid and what does it do?

  19. Linda m

    I haven’t had sex for 7 years. I can hardly stand the pain from my doctors GYN exam. She didn’t want me to go in osphena But I need help

    • Susan

      Just started taking it two weeks ago I know it could be weeks to see any difference I literally saw a difference in a week my vagina is moister sex is not as painful definitely not as dry it’s working like 98.9% in a positive way for me I have had a hysterectomy and am post menopausal.

  20. K Marin

    As a 55+ women who finished menopause, for the most part, I found myself suffering from Atrophic Vaginal Atrophy and such horrendous pain during intercourse that penetration was impossible. A friend recommended I try Osphena and considered it a miracle drug. By the time I finished the 15 day trial my GYN had given me, I wished I would just die. Seriously, my vagina looked like I had rubbed it with poison ivy. It was unrecognizable. I was tested for every STD, etc. known, more than once and even treated with drugs that are for STD’s. All tests were negative. All drugs failed. Six months later I still have itching and a vaginal infection that is resistant to every drug we’ve tried. MY ADVICE is DO NOT TRY this miracle drug. I would not wish this on my worst enemy!

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