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. Amy
    New Iberia

    I am 41 years old and have been prescribed Osphena. Not sure why. I had a partial hysterectomy, and my cervix wasn’t removed so sex is painful. It’s been one week since Osphena. I have already experienced hot flashes, night sweats, achy joints, and insomnia. I am irritable. I think the insomnia is the worst. I stopped taking it.

  2. Kim

    I have been taking Osphena fo about 3 months and sex definitely has become less painful for me , but lately have noticed that my breast have become tender. I haven’t contacted my doctor yet. I was wondering if any of you ladies have noticed that. And if you were advised to stop taking Osphena?

  3. Jeanette M

    I was on it over two years reading not for long term stopped six months ago. OMG the pain is back, now trying again to figure out how to afford $227 Month as insurance company doesn’t cover it and my gynecologist says this is what I need? I’m 57 started menopause at 50 sex is severely out of the question.

    It’s great then after get worse and UTI. So drug does work however not being able to pay for it As osphena heled me twice I was paying $100. Now up to me to figure it out ! Seems hot pack is it ?

    • Sherry

      I just started Osphena but before I used Dong quai to
      Help with dryness. It wasn’t a total cure But it did help
      With the everyday painful dryness, so bad it hurt to walk
      Or even wipe. I am hoping the Osphena will help me get
      Back my sex life. As that is still usually painful and I
      Have almost given up for the last few years. Really
      Is unfair to lose that part of your life after menopause.
      So praying this helps.

  4. mary
    staten island


    I am 63 years old. I’ve been on Osphena for 2 years, the only thing it helped with was the burning. Sex is still very painful for me because of the dryness. MY GYN just started me on estradiol cream in compound with no additives (pure). I’m still burning what is the solution? I’m totally unhappy.

  5. Christine
    Rhode Island

    I have been taking Ospena for about 6 months or more. The price is too high $250/mo. and not covered by my insurance – VERY UNKIND -But, I have found it to be a wonder drug!

    I was concerned about cancer issues, but I would tear my labial tissue by just wiping gently! Sex was a painful and bloody mess even with lube! I was started on Estrace (helped slightly), then Estring (which actually did help a bit) and then was offered Ospena!!!! Within a few weeks (if that) my body started producing vaginal fluid again! I now have sex like I am 26 not 56!

    Yes, I am divorced and have met a new man, but so many of my friends say their sex life is OVER due to pain, dryness and discomfort. Women (and their partners) should not have to give up all of the positive health effects of a good and satisfying sexual relationship due to vaginal atrophy (I HATE that word!). We just need to find a way to make this drug more affordable and covered – as necessary – on insurance! I also only take it 2 or 3 times a week to save on money. If I take it the day before sex I am all set! I hope this helps.

    Also, I have a spine full of degenerative disc disease and arthritis and I have NOT had an increase in joint pain. Actually the opposite. I am happier and want to walk more and stay more fit… it is the trickle down effect (opps, bad humor).. bottom line – it works!

    • Gidgett

      My doctor faxed my prescription to Osphena Company and gave me the number to call to mail order and pay. I pay $50 for a 3 month supply. U can also google a coupon for Osphena and find up to 75% off to use at your pharmacy.

  6. Virginia
    Decatur, AR

    I have been taking it for about a month and the pain and dryness is better.
    However twice now when I have had a orgasm I had a severe headache that flashed across the back of my head and then felt like it flashed through my right eye. It only lasted a minute and was nauseated for a few minutes.
    I don’r know if this is related or not but will hold medicine till I speak with my doctor.

  7. Kimbo

    My Dr just prescribed osphena, about how long does it take to see any positive results ?

  8. jmk

    I have been using Osphena for 10 months. I no longer have vaginal dryness. I felt relief after a few months but I am now having pain in the joints of my fingers and have burning in the vaginal area on the outside. Going for hand x-ray this week to see what is causing finger pain. Has anyone else had joint pain in their fingers? Some days I have no pain but other days I do.

  9. Barb

    I have been on Osphena for 9 months I had the painful intercourse severe dryness burning just to be completely honest I felt like I had glass in my vagina thats the best way to describe the pain, it took about six months of being on Osphena before I really seen inprovements now a nines months iI feel normal again !

    I know ther are side effects but for me my comfort and being able to have my life back is worth it, I couldn’t hardly walk so this wasn’t just about sex, things were so bad everyday task were almost impossibe for me!

    I tried other things first I use estrace for 6 mons did not help at all and use replens no help either along with different lubricants nothing work, OSPHENA has helped me and I am thankful for my doctor prescribing it for me!!!

    • Debbie
      Los angeled

      Omg. Me too. I also starting itching on my back. Yikes. Bring 64 is no fun.

  10. Barbara

    I have used Osphena for nearly 3 years. It works well–vaginal dryness and tender tissues are gone. However, since I worry about cancer and the other complications, for the last year and a half I have only taken one tablet every 3 days. It is enough to help, but hopefully it is not enough to create serious problems.

  11. DD

    There is a rare infection called Desquamative Infectious Vaginitis aka DIV that is not being diagnosed by Drs. who usually think it is a UTI or Yeast Infection, etc. It is hard to diagnose.

    Symptoms are vaginal dryness & intense vaginal pain in general. There is usually a heavy, thick discharge which does not smell but is yucky to say the least. The lining of the vagina actually sloughs off causing these symptoms. Your vaginal are will be extremely red. It hurts to sit down when you have full blown DIV.

    Please ask your OBGYN to test for this hard to treat, hard to diagnose infection or you will NEVER find relief if you actually go untreated. It took 6 months for my Dr. to figure it out.

    And the treatment takes time but at least you can find relief. When you have DIV, sex is out of the question until you get treatment. Believe me, it is the last thing you will even consider.

    I hope that the ladies out there who have been miserable for so long will please ask about this.

    A simple vaginal swab will determine diagnosis!

    • JP

      I was diagnosed with DIV this year, very frustrating horrible condition. What does your doctor prescribe for treatment of flareups? Hydrocortisone suppositories have worked for me, but it continues to recur after stopping the meds.

      I have not used clindamycin yet, but am considering using next to see if that might cure. I have been using local hrt’s (vagifem, yuvafem, premarin) 2x week for last couple years, but specialist suggesting adding replens as well. So helpful to find others who suffer from this, doesn’t seem like there are many of us. Would love any advice.

  12. Elaine

    I have been taking osphena for about 2 months now. It has changed my sex life!! No pain, I am super lubricated and sex is fantastic!! I do feel a bit queasy sometimes but I will work through that to feel like I am 21 again! I also get some warm flashes but nothing too serious.

    • Rosemarie

      How old are you? I am thinking of trying this drug but am frightened. I am 62 and have vaginal atrophy.

      • Gayle

        I am 55 and have been on osphena for a little over a year now. I feel like it saved my marriage! It hurt so bad to have intercourse with my husband ( who we have been together for 18 years now). It’s absolutely no fun to have sex and it hurt like it did, It made me hate to be intimate with my husband. I think it is the best thing since sliced bread. Replens didn’t work at all for me. what will we do say 3 or 4 years from now if you should not take it for an extended period of time???

  13. j

    Reading all of this, I am amazed that no one has mentioned Estring!

    It’s an estradiol infused silicone ring that you use for 3 months at a time. I have used it for years, am 63, and although sex got painful after a long stretch of no sex due to prostate surgery, with a little practice I am ok again. Use it or lose it!

    I tried Osphena once, and actually thought it improved my libido, and dryness issue was fixed, but had a few problems. Memory issues, urinary continence issues, achy joints. So I went back to osphena. Try the ring!

  14. Nancy

    I am 69 and was on a low dose of estrogen for bone density, vaginal dryness, et. al. Last year I was diagnosed with estrogen positive breast cancer, so there went the estrogen. I have finished treatment and, as far as we can tell, am cancer free, but now I am on Femara to prevent recurrence and I am getting bladder infection after bladder infection. I will finish a bout of antibiotics and within a week will have another UTI.

    One doctor suggested Osphena to remedy the vaginal atrophy that makes me susceptible to the infections. Does anybody know anything about this?

    • Tina

      I take a low-dose of Nitrofurantoin to prevent urinary tract infections. You might try that?

      • Donna

        The macrobid works wonders & there’s no antibiotic resistant build up associated with it because it narrowly targets the UTI issue. I was sick for years before I was prescribed this as needed.

    • Jill

      For UTI I have been able to finally not have a recurrence by using D-Mannose powder. I used 1 tsp in 1 cup of water 2 times each Sat. and feel I have successfully removed the bacterial plaque that had been causing recurrent UTI infections despite strong antibiotics, more water hydration, etc. D-Mannose affects the bacterial colony’s ability to form a protective shield plaque to prevent it from being flushed away. You can use the D-Mannose daily as well if you need to initially, and then less often prophylactically. I use Osphena without side effects except the weight gain which I had to work hard and alter my diet to remove the 17 lbs I had gained. I had UTI problems until the D-Mannose. Now none have occurred in 2 years! Yay!

  15. Cheryl R.

    I’ve been on Osphena for two weeks now, and while intercourse already seems less painful, I find that I’m becoming ridiculously emotional. It’s almost like I’m PMSing, and at 62, that’s totally unacceptable! I can’t take this restless, uneasy irritability. Has anyone else experienced this?

  16. norma
    wichita, ks

    I was taking estrdiol. the dr, put me on osphena. which is best for burning in the vagina and constant urination?

  17. Marie

    I’ve been taking Osphena for a year. I stopped, and my symptoms seem to be back. Osphena has worked great for me.

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