How to pick the right local estrogen for vaginal dryness

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madman

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How to pick the right local estrogen for genitourinary syndrome of menopause // There are many ways to safely treat vaginal dryness, now called genitourinary syndrome of menopause. The safest and most effective treatment for vaginal dryness during and after menopause is vaginal estrogen. In this video, I walk you through how I help my patients make decisions on which type of vaginal estrogen is the best for them depending on their menopausal symptoms.

Summary​

Dr. Heather Hirsch discusses the benefits of vaginal estrogen for treating genital urinary syndrome of menopause (GSM) and explains how to choose the right type of vaginal estrogen based on the severity of GSM symptoms. She also mentions alternative options for milder cases and provides a pro tip for managing painful intercourse.

Highlights​

  • ⚕️ Vaginal estrogen is the safest and most effective treatment for GSM.
  • Symptoms of GSM include pain with sex, burning with urination, frequent urinary tract infections, and dryness.
  • ️ Loss of estrogen during menopause leads to changes in tissue pH and reduces blood flow, causing discomfort and dryness.
  • Lubricants and moisturizers are helpful for mild cases but cannot reverse GSM.
  • Creams (estradiol and Premarin) are recommended for severe GSM due to their efficacy, flexibility, and benefits for external tissues.
  • Inserts or suppositories (vagifem) are suitable for mild to moderate GSM and are less messy than creams.
  • Prasterone (intrarosa) is a suppository option that combines the benefits of creams and suppositories but may be more expensive.
  • ⚠️ Pro tip Communicate with your partner about avoiding intercourse for 12 weeks to break the cycle of painful intercourse and seek professional help if needed for pelvic floor dysfunction or vaginismus.
 
 
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Lakshman KM, Kaplan B, Travison TG, Basaria S, Knapp PE, Singh AB, LaValley MP, Mazer NA, Bhasin S. The effects of injected testosterone dose and age on the conversion of testosterone to estradiol and dihydrotestosterone in young and older men. J Clin Endocrinol Metab. 2010 Aug;95(8):3955-64.

DOI: 10.1210/jc.2010-0102 | PMID: 20534765 | PMCID: PMC2913038

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