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Vaginal Dryness: It’s Not Just You

While maybe not the most comfortable topic to discuss, we understand how common of an issue vaginal dryness is for women. We want you to know that you are not alone. It’s a common problem and we are here to provide you information to help you address your concerns.

Vaginal atrophy, also often simply referred to as vaginal dryness is a common disorder that affects millions of women in the United States and is caused by a lack of lubrication of the vaginal walls.  For these women, it is a real problem that affects and interferes with their day to day lives.  Its effects can range from minor discomfort to painful sexual intercourse.

Vaginal dryness can occur at any age; however, nearly half of all women between the ages of 40 and 59 will suffer from this problem.  As a woman transitions into menopause, the hormones in every healthy woman’s body will start to decline which can be associated with a variety of symptoms.  Some of these symptoms can include hot flashes, vaginal atrophy such as dryness or discomfort, and trouble sleeping.

Under normal circumstances, the walls of the vagina are covered with a thin layer of fluid to help keep the vagina healthy and elastic.  This is partly due to a hormone called estrogen, naturally produced in women’s reproductive organs, that helps to maintain healthy vaginal tissue and keep it lubricated.

Whenever a woman’s estrogen levels begin to drop due to menopause, a hysterectomy, or any other reason, the lining of the vagina begins to thin which reduces the amount of moisture it produces.  This can cause a number of unwanted problems such as itching, burning, discomfort, painful urination, and painful intercourse, all of which are associated with decreased libido.

Menopause, whether natural or surgical is the most common cause of a woman experiencing vaginal dryness, and one of the most effective treatment options for this problem is estrogen therapy. There are quite a few drug products on the market that are designed to combat vaginal dryness:

Oral Estrogens

While oral estrogens may be effective, they can have many unwanted systemic side effects such as headaches, breast tenderness, breast cancer, and endometrial cancer if used for prolonged periods of time. We do not advise oral estrogens to be used as a first line treatment option for vaginal dryness.

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Commercial Topical Estrogens

These products are a better option to treat vaginal dryness than oral estrogen therapy, but are typically quite pricy and not covered on insurance. The two most common commercially available products on the market right now are Estrace™ and Premarin™ vaginal creams.  Estrace™ is brand name estradiol cream that can run anywhere from $270-$350 cash since insurance companies do not often cover brand name products.  With Premarin™, you are looking at around $320-$360 a month with their coupon cards.  This will end up costing you around $3,240-$3,840 for a year’s supply of these medications, respectively.   Even if these products are covered by your insurance, many are considered “non-preferred” brands and therefore carry a higher copay.

Compounded Topical Estrogens

Collier Compounding offers a few alternative and less expensive options to these commercial products that are available. We compound an affordable estriol vaginal cream indicated for vaginal dryness and its associated symptoms.  Like estradiol, estriol is a form of estrogen, but it has a higher affinity for vaginal tissue (meaning the estrogen binds to receptors more strongly). Estriol also does not convert to estrone (the type of estrogen believed to be linked to increased risks of cancer) so it can be argued that it has an even lower chance of causing some of the negative side effects associated with estrogens.  Estriol also has a long half life, meaning it stays in the body for a longer period of time, so it may be dosed every other night making it a very convenient therapy for many women.

All of our compounded vaginal creams will be around 15-20% of the cost of the commercially available options per prescription, which is money directly back into your pocket.

Other hormones such as progesterone and testosterone can be added to the estriol cream depending on the needs of each individual woman.  There are often other fluctuating hormones that play a role in the problems causing vaginal dryness, and since every woman’s body is unique, it makes sense to be able to customize each woman’s hormone therapy based on their individual needs instead of using commercial products that use a “cookie-cutter” approach to hormone therapy.

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Compounded Non-Hormonal Vaginal Cream

In certain circumstances, such as a history of cancer, hormone therapy is contraindicated and it would not be appropriate to initiate an estrogen cream to treat vaginal dryness. If this is the case with someone or if they would just prefer to start with something other than a hormone cream, Collier Compounding offers a hormone free alternative; hyaluronic acid vaginal cream.  Hyaluronic acid is a “biologic shock absorber” traditionally used as an injection to help lubricate old joints.  We formulate this product into an easy to use vaginal cream that has been shown in one study to improve the symptoms of vaginal dryness.  It helps to form an extracellular water film which moisturizes the skin, maintaining a water balance that aids in skin elasticity.  Vitamins A and E are also added to this cream which can facilitate the healing process and tissue regeneration through their antioxidant and anti-inflammatory properties.

References:

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Rosenberg MJ, Waugh MS, Meehan TE. Use and misuse of oral contraceptives: risk indicators for poor pill taking and discontinuation. Contraception 1995; 51:283.

Soules MR. Development of a staging system for the menopause transition: a work in progress. Menopause 2005;12:117-120

Dennerstein L, Dudley EC, Hopper JL, Guthrie JR, Burger HG. A prospective population-based study of menopausal symptoms. Obstet Gynecol 2000;96:351-358

Nelson HD, Haney E, Humphrey L, et al. Management of menopause-related symptoms. Evidence report/technology assessment no. 120. Rockville, MD: Agency for Healthcare Research and Quality, March 2005. (AHRQ publication no. 05-E016-2.)

Leiblum S, Bachmann G, Kemmann E, Colburn D, Swartzman L. Vaginal atrophy in the postmenopausal woman: the importance of sexual activity and hormones. JAMA 1983;249:2195-2198

Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA 2002;288:321-333

J Sex Med. 2013 Jun;10(6):1575-84. doi: 10.1111/jsm.12125. Epub 2013 Apr 9

Menopausal Symptoms: Comparative Effectiveness of Therapies, Grant MD, Marbella A, Wang AT, Pines E, Hoag J, Bonnell C, Ziegler KM, Aronson N., 2015 Mar.

 

Article Written By: Andrew Criswell