Are you experiencing vaginal discomfort during menopause? You’re not alone. Known in the medical community as a genitourinary syndrome of menopause (GSM), this sensitive issue affects about half of all women at this stage of life. That discomfort can range from itchiness, to sandpaper-like dryness, to pain during sex. If you’ve dealt with it, then you know it can affect your quality of life, not to mention your ability to enjoy sex.
Luckily, there are a number of products on the market that can address GSM, including vaginal estrogen creams. “They are considered the most effective treatment for GSM,” Dr. Kathleen Jordan, MD, menopause certified provider and chief medical officer of Midi Health, tells Flow Space.
To get vaginal estrogen cream, you’ll first have to talk to your PCP or OB-GYN about your symptoms — which, for the record, is something that not enough women feel comfortable doing. There’s still so much stigma surrounding menopause that Jordan makes it a point to ask her menopausal patients about vaginal and urinary issues explicitly. “I encourage women to bring this issue up to their clinician,” she says. “Too often, it goes unaddressed.”
Luckily, a more recent telehealth option gives women the ability to connect with a provider online and get a prescription estrogen product sent directly to them. Here’s everything you need to know about vaginal estrogen, including how it works, the pros and cons of using it, and where to get it online.
Vaginal estrogen creams are a form of hormone therapy (HT) commonly prescribed to treat vaginal dryness, itchiness, and/or painful intercourse during menopause. As the name suggests, they contain an ultra-low dose of the reproductive hormone estrogen, usually a form called estradiol.
During menopause, a person’s estrogen levels naturally drop, often causing their vaginal tissue to become drier and more prone to irritation. These creams are applied topically to the vulva and vagina, which is “rich in estrogen receptors,” Dr. Alyssa Dweck, MD, a gynecologist and chief medical officer of Bonafide Health, tells Flow Space. They help to restore elasticity in the affected area and relieve irritation or pain. Aside from creams, estradiol can also be administered via suppositories, vaginal tablets, or rings.
Jordan notes that estrogen cream isn’t always the first line of defense for GSM, nor is it automatically the best option for everyone. It all depends on a patient’s needs, preferences, and what may or may not be covered by their insurance. Non-prescription vaginal moisturizers and lubricants, many of which are hormone-free, can also be used to treat symptoms.
Since they’re FDA-approved, vaginal estrogen creams are a safe and highly effective treatment option for GSM. They work quickly to alleviate discomfort, restore your vaginal PH, and improve your sexual health. These creams can also minimize your risk of painful urination, incontinence, and recurrent urinary tract infections (UTIs), all common symptoms of GSM.
As a topical form of HT, vaginal estrogen is much more localized than, say, taking an oral tablet or using a transdermal patch to administer estrogen. Those methods raise your systemic estrogen levels, Dweck notes, which, over time, may lead to more undesirable side effects.
Estrace, which contains 0.01% estradiol, is the most commonly prescribed vaginal estrogen cream. It’s applied vaginally with an applicator. Those who prefer a ring might opt for Estring, which is inserted manually and switched out every three months. “Some women like not having to worry about it except four times per year,” Jordan explains, “while others prefer the soothing nature of creams and want to avoid insertion.” And then there’s Vagifem and Yuvafem, two popular brands that offer estradiol-based vaginal tablets.
If prescriptions aren’t an option, you can try non-hormonal products. Bonafide Health offers two: Revaree and Revaree Plus. Both are vaginal inserts that use hyaluronic acid — a naturally occurring moisturizer that also declines in the body with age — as the active ingredient. In one study, hyaluronic acid-based suppositories were found to be just as effective as estrogen-based creams in relieving vaginal dryness.
You can also try OTC vaginal moisturizers like Julva or Replens. These can be used a few times per week. The former contains DHEA, which isn’t as potent as estrogen-based products; however, it can work for people with mild symptoms, Jordan says. Of course, doubling up on lube during sex to counteract excessive dryness is always a viable option, too.
To reiterate: If you’re at all concerned about menopause-related vaginal dryness or painful sex, bring it up to your doctor, or consult with a menopause specialist. They’ll be able to walk you through different treatment options and identify what’s best for you. “It can be important to have an in-person evaluation to ensure that there isn’t something else [going on],” Jordan says, “like lichen sclerosis or other skin conditions that might be contributing to symptoms and would be treated differently.”
Vaginal estrogen obviously contains synthetic hormones, which can exacerbate certain health conditions and may not be right for everyone. “All FDA-approved estrogen-containing products will contain a package label with warnings” for a number of life-threatening issues, such as blood clots, cardiovascular issues, and uterine cancer, Dweck says. However, because its application is so targeted, those health risks are “incredibly low” when it comes to vaginal estrogen. Contrary to popular belief, it’s also been proven that HT doesn’t increase your risk of developing breast cancer.
Vaginal estrogen creams can be quite messy to apply, hence why someone might prefer a vaginal suppository or ring. Additionally, there’s a potential for user error with this mode of application — think: applying a cream incorrectly or too infrequently to see results. They can also interact with other medications you might be taking too. That’s why it’s a good idea to talk to your doctor and review your options together.
Yes, you can buy vaginal estrogen online, but only with a prescription. The good news? They’re typically covered by insurance, Jordan says, and depending on your insurance plan, you might be able to consult with a telehealth provider and get a prescription-strength cream mailed to you. Keep reading to check out your options to buy vaginal estrogen online right now.
