Key Takeaways

  • Women using vaginal estradiol experienced a significant improvement in their social, physical and sexual symptoms, showing the importance of encouraging a dialog between women and their health providers during and after menopause
  • One study found that both hormonal and nonhormonal treatments provide safe, effective relief for vaginal discomfort, with the best results coming from the use of vaginal estradiol
  • About half of women who have been through menopause suffer from vaginal dryness or discomfort that negatively impacts their quality of life, but many are afraid to ask for relief from their physicians

About half of women who have been through menopause suffer from vaginal dryness or discomfort that interferes with their ability to enjoy a good sex life. There are treatments for this condition, but many women are afraid to talk about it with their doctors.

The women's health experts at Massachusetts General Hospital believe that needs to change. They've recently published two papers from a clinical trial that they hope will help guide conversations between women and their physicians, and point to potential treatment strategies for women in menopause who are facing vaginal discomfort.

Vulvovaginal Dryness Clinical Trial

Led by Caroline M. Mitchell, MD, MPH, researcher with the Vincent Center for Reproductive Biology (VCRB) and director of the Vulvovaginal Disorders Program at Mass General, the clinical trial involved 302 women who received one of three treatments:

  • Low-dose estradiol tablet plus a placebo gel
  • Vaginal moisturizer with a placebo tablet
  • Placebo tablet-moisturizer combination

Dr. Mitchell and her team found that the majority of the women in the trial reported improvements in their symptoms. This was even true with those who received the dual placebo. The women who used vaginal estradiol plus the placebo pill had the best overall outcome.

For most women, Dr. Mitchell said, the relief from these treatments can be transformative.

Improved Quality of Life Through Treatment

Historically, the most common vaginal symptoms experienced by women after menopause are itching, dryness, irritation and pain during intercourse, with sex-related pain cited as the most common symptom during the study led by Dr. Mitchell. Over the course of the 12-week trial, all of the women reported a decrease in intercourse-related pain. Those results were published in JAMA Internal Medicine.

In a second analysis of the same trial, which was published in the journal Menopause, the same findings rang true, with a slight advantage revealed among the women who used vaginal estradiol. To come to this conclusion, study participants were asked to fill out a Menopause-Specific Quality of Life (MENQOL) questionnaire, in which they rated their social, physical and sexual symptoms on a scale of zero to six, with six being "extremely bothersome." The participants were also asked to rate their vasomotor symptoms, such as hot flashes and night sweats.

The study found that women using vaginal estradiol experienced a significant improvement in their MENQOL scores, while the women taking a placebo did not. The participants also filled out surveys that measured their general anxiety level and physical health, but neither treatment group showed an improvement in those measures when compared to responses from the patients who were taking a placebo.

Empowering Women to Seek Relief

So what stops women in menopause from requesting relief from vaginal discomfort?

"They just assume that it's part of aging for women and that there is nothing they can do about it," Dr. Mitchell said. "It is not talked about. This has to change."

Dr. Mitchell added that some women may think that taking estradiol, a form of the hormone estrogen, is risky. However, she explained, in low doses (like the formulas used for her study), it is generally believed to be safe.

As for the overall message of these two studies: There are safe and easy treatments for vaginal discomfort available, and expressing the need for such relief should be encouraged.

Dr. Mitchell hopes that these findings will inspire women to take control of their pain by reporting their symptoms and requesting treatments.

"Of every person in the study, the majority had an improvement in their symptoms," she reiterated. "This suggests significant relief is readily available, safe and cheap for most women."

Department of Obstetrics & Gynecology