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. Rachel L.
    Reply

    I underwent a hysterectromy at the age of 31. I was left with 1 ovary so that I would not need to undergo hormone replacement therapy. There was also, no problems with that particular ovary at the time. Well, things have changed. I am now 38, and over the past 2yrs, I have had to take Premarin off and on for vaginal dryness issues… so bad that I would bleed after intercourse
    I had hot flashes and night sweats immediately after my surgery as well. My ovary does not behave itself (sigh). So… now it’s on the fritz, and I was given Osphena. I hate it. 5 days after taking it, I came down with a yeast infection. I have had it for 3wks now. It will not go away. I am going to make an appointment with my gynecologist today, but the drug that is commonly prescribed for troublesome yeast infections reacts negatively with Osphena, so I am not too happy about that and not sure what to do.
    I have gone through 3 boxes of yeast cream. It also causes indigestion. That’s my experience with it anyway.

  2. AK
    Reply

    Has anyone else tried the Hyaluronic Acid for this problem?

  3. Fran
    Reply

    Hi, was wondering if your breast cancer was estrogen positive???
    thanks

  4. NancyCL
    Reply

    As posted in another section about this problem, I started using Organic Coconut Oil. I find it works quite well, for both partners, and for dryness, it also works to insert about a half a teaspoon full into the vagina. This seems to be a miracle drug, as it also works as a wonderful moisturizer among other things. Good luck to you and I hope you find a solution that’s right for you. :-)

  5. DW
    Reply

    I am 56, and always enjoyed an active sex life when married. My husband passed away several years ago, and that ended that. However, I have recently met someone I might decide to have a relationship with; however, I am scared to death to have that sexual relationship due to all the frightening things I have heard that have happened to my body. During my pap smears, the tool the doctor uses is painful enough, let alone having sex. My doctor put me on Osphena, but said it might take up to 12 weeks. Any suggestions? I have enjoyed the advice given by others, but still am not sure what to do.

  6. NancyCL
    Reply

    This is good information, but what about those of us who have had hysterectomies and do not have our ovaries, so we are not producing estrogen or progesterone? I don’t think that would work for us. But it would be great if if did! :-(

  7. NancyCL
    Reply

    I’m so happy so many are contributing info about this problem, and also to learn there are alternatives to “suffering”. I have been on Premarin cream for three months, and I find it is helping somewhat, though intimacy is still very painful. One thing I’ve noticed recently is that I am beginning to itch “down there” and wonder if it’s due to the prescription.
    I do not have to see my doctor until next month, but am considering stopping the Premarin. One benefit I am finding from it though is that it helps with constipation which I have had for a long time. So I wonder if some of the benefits outweigh the risks. It’s so frustrating to have to deal with this at our age when we should be enjoying our “golden years” and not having to deal with this. Thank you all for your comments and suggestions. At least we are all “sisters” sharing in this together.

  8. M. H.
    Reply

    I am 60 and have been menopausal for a while. I suffered from thinning skin in the vaginal area and painful intercourse that got worse with time. This reached the point that the area developed atrophy and I thought it could possibly be cancer.
    Thankfully, the gynecologist prescribed estradiol vaginal cream for me and within two weeks, the area was much improved I am very glad that I didn’t scare away from trying it. By the way, my general practitioner did not know what my condition was and referred me to the gynecologist, so seek specialists should you develop problems.
    Lack of estrogen can cause more problems than I was ever aware of and I regret waiting so long to seek professional advice and treatment. I know there are scary stories out there of side effects of taking hormones, but I wish I had known the hazards of not taking them as well. Good luck to you all, regardless of your path.
    To Cindy M.B.: thank you for sharing about the hyaluronic acid…I will be giving that a try as well.

  9. NancyCL
    Reply

    WOW, thanks much for the info. Anything without the use of hormones and that doesn’t have any side effects sounds good to me. Also, the added benefit of helping give you moisture in your skin as well as helping the joints sounds awesome!

  10. Cindy M. B.
    Reply

    I’ve written this once before but it bears repeating. After the “dreadful M,” sex became painful and almost impossible. I tried the “ring,” an estrogen product you place up inside, but that caused a terrible yeast infection. I tried all kinds of lubricants, but they lost their slipperiness before correcting the pain and dryness — especially the pain. Then I tried HYALURONIC ACID! It’s in some topical products (creams, etc.) but I take the capsules, which are more common. Hyaluronic acid adds moisture to skin, tissues, joints, etc.
    I wasn’t thinking of the situation “down there,” but I wanted to lubricate my knee joints from within for easier skiing. What a wonderful surprise when the dryness “down there” started disappearing shortly after I began the HA. Now I have sex any time I please, and the pain and dryness are so minimal that it really isn’t a problem anymore. YAY! Anyway, hyaluronic acid tabs/capsules are available in any good supplements section. I follow the package instructions and take the higher dosage of the range they recommend. It’s a little bit expensive but so very worth it! My knees are doing well too. PS: I really don’t think the topical creams would be good for “down there;” topical HA is usually in facial beauty products and such.

    • Sarah
      Oklahoma
      Reply

      Where do you get your Hyaluronic Acid capsules….(brand, where you bought it, etc..) any information regarding them would be greatly appreciated… And if still taking, how is it working for you? Still good?
      I’d really appreciate it if you could let me know…

      Thanks!!
      Sarah

  11. KH
    Reply

    I have learned from reading the books by Dr. John Lee that menopausal women lack the hormone progesterone and that if we apply the natural bio-identical progesterone cream to areas where we blush,, we don’t need to take any estrogen at all..ever. His medical journals all reflect this and I learned early on to take only natural bio-identical progesterone ..it really worked for me and got me through the menopause years. I still put a dab of cream in different areas at bedtime..sometimes on my wrists..sometimes on my neck or cheeks.. He called the condition at menopause..estrogen dominance and theorized that we need to balance estrogen with progesterone because only progesterone is diminished starting at age 35 and onwards through the peri-menopause years to age 50 and beyond. I also found that natural progesterone had a calming effect on my mood and helped me sleep better. This was my experience. I hope it helps someone else.

  12. SP
    Reply

    I have metastatic breast cancer, and my oncologist has prescribed Vagifem which is an estradiol. From everything I have read, and my oncologist agrees, there is no risk of the estradiol encouraging the further growth of the cancer which is now in remission. If I can use it, it should be pretty safe for those who do not have breast cancer.

  13. Mariellen G.
    Reply

    I alternate between an estriol cream and olive oil. I use the olive oil until I start to itch, then use the estriol awhile. Estriol was FDA’d off the market for awhile, but is now available again. I’ve used estriol creams since 1998. No cancer yet…. And my mother had a hysterectomy for cancer when she was 10 years younger than I am now. Mainly I take the estriol route because of UTIs — I’d read that the reason old ladies get UTIs, which leave them disoriented, is that they lack estrogen. I can avoid that whole UTI/antibiotic/worse UTI/bigger antibiotic merry-go-round by using the estriol cream when The Itch tells me I’m a prime target for a UTI.

  14. NancyCL
    Reply

    You are talking about tablets/capsules, right? After my hysterectomy 7 years ago, I was put on the Estradiol patch, but I was only on it for three months for fear of being on them longer. They did help (a bit) with the night sweats and hot flashes, but as for vaginal dryness and painful intercourse, they didn’t offer much relief. I also tried that Estroven sold over the counter, and that didn’t do anything but empty my wallet! Hope this helps.

  15. NancyCL
    Reply

    Maybe this woman ought to try the Coconut Oil that has been commented about in previous issues. I am on Premarin now, but when it is gone, I am going to go with the coconut, which is all natural and sure to help the problem.

  16. Mary
    Reply

    I would check with others regarding how to decrease discomfort from vaginal dryness.
    One thing I would test personally is manually applying a little coconut oil as long as I haven’t had any difficulties with it.
    Drugs for it all seem to have possible heavy duty side effects.

  17. Sheila P.
    Reply

    Would like to know if you could tell me a little more about”estradiol” 0.5 mg. Dr. prescribed these for me and I am scared to take them. Afraid they may case cancer. I’m 52 and had a full hysterectomy. Was prescribed for vaginal dryness and soreness. Any info would be great.

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