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. Lisa L.
    Reply

    I just got prescribed Osphena yesterday. I asked my doctor if there were any side effects and he said no but this is not corresponding at all with what I am reading here so now I am scared to take it. I didn’t realize until reading this column that so many, virtually all post menopausal women have painful sex. Regarding the chronic UTI’s, I am 56 and had a “bladder wash” last year b/c I had had 6 UTI’s in 5 mths, neither my G.P. (a woman) nor the Urologist mentioned that it could be related to low estrogen.
    I am Canadian but living in the U.S. and am concerned that Osphena is not available on from my online Canadian pharmacy where I get my Retine-A at $70 (including shipping) where the Pharmacies here (my insurance no longer covers it) are asking $700-$900. -I wonder if “Osphena” hasn’t been approved in Canada and that worries me.

  2. Fina96
    Chicago
    Reply

    I am 60 and the vaginal dryness is so upsetting to me. I tried YES. I think it moisturizes but after using it for a few days, there is a discomfort/tingliness.

    I tried olive oil which was good. I then tried coconut oil. It worked fine. I used a little in the morning and and at bedtime. My gynecologist said, upon examining me that the moisture improved.

    A couple of weeks ago I got a UTI. I stopped the coconut oil thinking it was that. In discussion with the dr. she said to go back and use it because if I had been using it for 9 months with no problem, then it probably wasn’t what caused the UTI. So many things can.

    So, I am thinking I should try again. Any brand anyone suggests? Has anyone had experience getting a UTI from coconut oil? Should I go back to olive oil? Any brands you recommend? Replens? Read reviews and they are not all great.
    No estrogen or osphena for me. My sex life is nonexistent right now and I don’t feel like myself. Very frustrated.

  3. Np
    Texas
    Reply

    At 68, I’m at an age when I thought sex would be a non-issue in my life. My husband doesn’t share my view but sex is uncomfortable AND I really don’t want it. I would LOVE something that would improve my libido, not to mention relieve the pain of intercourse. How nice it would be to have an enjoyable sex life again. I don’t know what the coconut oil treatment is about and never heard of coconut oil capsules until I read this forum today.

  4. Mary Beth
    OR
    Reply

    I have been diag with Atrophic Vaginal Atrophy. Horrendous pain during intercourse. Dr prescribed Osphena. Immediately after starting on it, I go to bed and wake up after a couple hours wide awake. Anyone else have this?

    • Sherry
      Dallas, Texas
      Reply

      Mary Beth, yes. I have. I was on Osphena ten days before I noticed it and it persisted over time. I would wake up as if I had not been asleep at all, my mind racing like in an adrenaline rush. I continued to take Osphena because it worked wonderfully well for my vaginal atrophy. After five weeks, I discontinued Osphena because I needed the sleep and calm. The sleepless symptom disappeared immediately. The improvement for my atrophy lasted but diminishes.

      After four months off Osphena, I am now taking it again.

    • Nonny
      USA
      Reply

      Wow, I was just prescribed Osphena and I had that same issue the very first night after I began taking it. Very sleepless night with vivid dreams when I was able to doze off. At first I thought it was because I had gone to bed w/o taking xanax, as I commonly do at bedtime to be able to stay asleep. In subsequent nights it has been better, but that first night was horrible.

      I will give the medication a chance, because I really want to see some improvement for the vaginal atrophy that has virtually stopped our sex life, but ugh I am not looking forward to a return to night sweats and hot flashes. I cannot take estrogen because of a history of breast cancer.

  5. Carol
    Florida
    Reply

    I am a somewhat young 66 years of age (thanks to long distance running and careful lifestyle), but I had more than moderate age related issues with dryness, discomfort and bleeding. I began to use Osphena and within a week the problems resolved and my “love life” was resurrected. However, I am experiencing an allergic reaction that may or may not be related to Osphena use: my face has swelled and despite medications and prednisone use, the swelling has not abated over a 3 week period and continues to increase, than abate, then return. Will know more after blood test results indicate whether this is a different problem, or whether this is in fact an allergic reaction to Osphena. I do not have allergy issues with any other meds, or symptoms elsewhere other than my face.

  6. deb
    ri
    Reply

    was taking osphena and after several weeks I developed severe sensitivity to almost all clothing from the waist up, not sure if this is a coincidence but have not seen this listed as a possible side effect anyone else experience this type of itching/sensitivity?

  7. Shel M
    California
    Reply

    I had a TAHBSO ( Total Abdominal Hysterectomy and Bilateral Salpingectony and Ooferectomy…both ovaries and tubes removed ) when I was 25. I am now 54 and just began Osphena one month ago. I can not take ANY estrogen. As an RN I was really worried about the side effects of this drug and did a lot of research. I can honestly say that my sex life with my husband was really painful and now it is not at all. However, I have begun having RAGING night sweats and heart pounding out of my chest at times during the day. Has anyone had any of these side effects?

    • Sheri
      wa
      Reply

      You are not alone. RAGING hotflashes and sweats was a daily and nightly issue. I would sweat through my clothing two to three times a day. I also started having issues with my tendons… painful tennis elbow and plantar fasciitis. I don’t see the tendon issue in any of the warnings, but the timing of these to tendon issues began at the same time the sweats started. Anyone else?

      • Sheri
        wa
        Reply

        forgot to say:
        I cut the dosage in half hoping to lessen the symptoms of both the sweats and tendon pain but both persisted. I took osphena at full dose for 3 months, 1/2 dose for 3 more months. I have since stopped taking it. The sweats have stopped, the pain with my tendons has continued… I REGRET having taken osphena.

      • Jill
        Northern California
        Reply

        Hi Sheri,

        I started taking Osphena in February had roughly a three week break from it because I had to leave on travel abruptly. I have sense started the medication again on April 21st. I have been experiencing pain in my shoulders, arms and back. It almost feels like I just stated working out again or I was beat up or something. I don’t see any of my issues listed as a side effect but I am seriously thinking about discontinuing Osphena.

  8. nancy
    Reply

    I seem to be the exception to the norm. I started osphena 3 months ago. I was using premarin cream.
    Within a month of starting osphena I noticed that I have a renewed sense of well being. I feel like a girl again. I’m losing weight! Yes, I know it’s amazing. I have had a decrease in hot flashes and I feel so good. I’m not sure if it’s the osphena or if it’s because I stopped the premarin cream. The dryness is not completely gone. The premarin was more helpful for that but it is much better than without the osphena. I love it. I’m hooked.

    • Nichole
      New York
      Reply

      Hi, thinking about asking my dr. about Osphena for vaginal dryness which I am sick and tired of. Using Estrace vaginal cream but its not doing much. Was wondering since it has helped you, do you have a uterus and do you need to take progesterone with it? I am postmenopausal with a uterus and afraid of taking something with might thicken my uterine lining. My only complaints are the dryness and low libido which is driving me crazy too, but I have no hot flashes at all. Any help would be appreciated. Thank you! :)

  9. Cathy M.
    akron, ohio
    Reply

    I’ve been using Osphena for six months… Wow what a difference in my life. I’m sixty and hadn’t had sex for five years because of excruciating pain. It took about four months of taking it everyday.
    I’m thrilled with the results and have had no side effects.
    I’ve been in menopause since age forty and have not had a hysterectomy.

  10. Kaye
    Reply

    Coconut oil is the best

  11. Tami M.
    Florida
    Reply

    I started menopause about 4 years ago. I am now 49 and started the discomfort with intercourse one year ago. I tried estrace cream and it worked great. My new doctor put me on Osphena, I have yet to see results. It’s been about a 1 1/2 months. I hear that it takes 12 weeks to see results. I am wondering if I can try the HYALURONIC ACID as well. Does anyone have a suggestion? Also, is Osphena something you take forever?

    • jess
      asheville
      Reply

      Hello,
      I’m 32 and through menopause when I was 22 (POF, premature ovarian failure). I’ve been on hrt for years, been through the hot flashes early on, but now I’m blessed with vaginisamis… however you spell it. My husband can’t penetrate at all, in other words. So, none of my doctors seem to care, all they see is an age. Until just recently, finally, one is giving me osphena. But, I am however curious about the coconut oil comment. I take it pill form, 1000mg, a day and love it. Could the one that left that comment elaborate?

  12. Rene
    USA
    Reply

    Wait until the lawsuits start pouring in over what this “miracle” drug has done to women’s bodies. It won’t be pretty.

    I am thinking the pharmaceutical companies have a stockpile of monies to fight the lawsuits and eventually settle, but until then, doctors (mostly male) will suggest this to their female patients. Honestly, this stuff is bad for you. Don’t do it.

    • Judith
      California
      Reply

      OK, let’s get real here. Men with ED have Viagra, Cialis, etc, while we women past menopause have virtually nothing to help with the pain of dry vaginas. What would you suggest to us? Do nothing? Don’t have sex? I lost my husband when I could no longer stand the pain of sex. He found someone younger. I, and I’ll bet many other post-menopausal women would be willing to try just about anything to have love in our lives again. I’m tired of the panic every new solution to this problem inspires. When Viagra came out (and IT too has side effects), men were lined up at their urologist. You didn’t hear doctors refusing them. This is a chauvinistic and Puritanical country that believes older women should just literally dry up, shut up and live alone.

      • Lynne
        New York
        Reply

        I am 57 and had a total hysterectomy with ovaries removed about 8 years ago. I too could no longer stand the painful sex and lost my husband to a younger woman about a year ago. I had tried everything out there. Either it didn’t work or I was allergic. You are absolutely right, I too would love to know that I could have someone in my life again. I was married for almost 40 years so the thought of dating again is frightening enough, and then to think about getting to the point of sex with someone and knowing how painful it has been has made me think I shouldn’t even try to date someone again. What a relief it would be if this medication actually works.

    • Lynn
      north carolina
      Reply

      Why do you feel this way?

      • BL
        Arizona
        Reply

        When the pain is so utterly excruciating, you are concerned about starting over with a love interest. Unless you have that pain, you don’t know.
        I’m also seeing a pelvic floor physical therapist. She knows what this is like and she’s 35. Many women have pain during sex and yet it’s a hidden issue.

  13. SusanJ
    Ohio
    Reply

    I had a complete hysteretomy at age 33, both ovaries removed, due to polycystic ovary disease. I have been on estrogen replacement therapy ever since — 23 years. While there is some risk of developing cancer, I am on the lowest dose that gives me relief from hot flashes, osteoporosis, and vaginal thinning and drying. Please do not be afraid to take the medications that are prescribed by your medical professional. If you trust your doctor, then rely on their knowledge to make you healthier, not less healthy. And don’t fall into the trap of “well, it’s natural.” Regardless of the source, everything you ingest or apply is made up of chemicals, so it doesn’t matter if they are “natural” or lab-created.

  14. 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.

    • jess
      Reply

      I’m the same age as you, premature ovarian failure, started hrt at age 22. Did osphena help you?

  15. AK
    Reply

    Has anyone else tried the Hyaluronic Acid for this problem?

    • Netty
      los angeles
      Reply

      I use boric acid suppositories for my yeast infections – it works great! Try it.

    • KB
      Indy
      Reply

      I have been ovaryless and uterus less for the past 5 years, my maternal family has a high incidence of brest cancer so I choose not to go on estrogen replacement… about 3 years later I thought I had a yeast infection and had itchy painful sex. After treating myself twice for a yeast infection I did some research and had the symptoms of Vaginal atrophy,,, my gynocologist confirmed this was the case,, she told me about osphena and I began to take it…. within 2 months my problems were gone,,, she looked at me and said it was all back to normal. I feel so much better because I am still young and want to have a relationship with sex as a part of it. The only thing is the cost is ridicoulus,, with insurance I pay 120/mth… This is the price I pay for a normal vagina,, sucks! But Osphena does work,,, and it’s worth the price I pay!

      • Angie
        MS
        Reply

        I just stated using Osphena after seeing the commercial several times on TV and asking my doctor if he would prescribe it. The pharmacy rep was in his office the next day and, although she had no samples with her, she told him to tell me to go to thr official website and print out coupons to help with the high cost. With my insurance, Osphena costs me only $40 for a month’s supply. With the coupons, however, my 1st and 4th months are free and my 2nd and 3rd months are $25 each. Many companies like this had rather give you significant discounts on their product OR even provide it to you free rather than have you NOT use their product (drug)!

    • Amanda
      Ohio
      Reply

      I have been using Osphena for months now and love it. If I miss a dose I will also get a yeast infection. My doc will call me in diflucan and it takes care of it. Love osphena

  16. Fran
    Reply

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

  17. 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. :-)

  18. 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.

  19. 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! :-(

  20. 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.

  21. 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.

  22. 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!

  23. 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

  24. 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.

    • Lynn
      GA
      Reply

      I was put on progesterone before my labs came back stating that my hormone level was not low for progesterone or estrogen even though I am 51 years old and have vaginal dryness. I have tried just about everything mentioned in the posts here. I tried coconut oil and it set me on fire. The progesterone made me sleep AWESOME but it also made me gain weight. Have you had any problems with weight gain?

  25. 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.

    • chris
      Reply

      Wow, I thought I was the only one here who thought like this.

      What IS the alternative?

      I miss sex.

      My BF [ companion] has stopped asking.

      I’m in my sixties with all the plumbing gone for a long time, but the pain started in my fifties, and I stopped trying.

  26. 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.

    • fina
      Chicago
      Reply

      I can’t take any estrogen. Came down with a UTI after nine months on coconut oil. Dr. said that it probably wasn’t the coconut oil that caused the UTI if it worked for 9 months. Tried YES organic… felt uncomfortable down there after using a few times. Tried olive oil in the past and had no problems.

      I have become afraid of everything now for fear of another uti! Wish I could find the right way.

      Yikes

  27. 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.

  28. 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.

  29. 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.

  30. 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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