Relieving Dryness and Pain: Which Vaginal Estrogen Is Best for You?
Key takeaways:
Changing hormones during menopause can cause bothersome vaginal and sexual-related symptoms — like dryness, pain, and low sex drive (libido).
Over-the-counter vaginal moisturizers and lubricants are the typical go-to options for these symptoms.
Vaginal estrogen products are also available with a prescription from your healthcare provider. These topical estrogen medications come in various forms, including creams, rings, and tablets.
GoodRx can help you navigate ways to save on vaginal estrogen medications, including exclusive savings on Premarin Vaginal Cream.
While menopause — a permanent stop to menstrual periods — is an ordinary part of life for many women who are 52 years of age or older, changing hormones during menopause can lead to bothersome vaginal and sexual-related symptoms. Some of these symptoms may include dryness, irritation, itching, and pain during sex.
Thankfully, over-the-counter (OTC) vaginal moisturizers and lubricants might help relieve some of these symptoms. If necessary, topical estrogen products — like vaginal estrogen cream — are also potential options. But these vaginal estrogen products are only available as prescriptions from your healthcare provider. In addition to a cream, vaginal estrogen medications are available as rings and tablets.
All of these vaginal estrogen products appear to be equally effective for vaginal specific menopausal symptoms. Additionally, long-term use of these vaginal medications isn’t linked to a higher risk of a thickened endometrium (uterine lining). So, prescription vaginal products are potential options for most menopausal women with or without a hysterectomy (surgical removal of the uterus).
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In this article, we’ll discuss more about vaginal estrogen prescriptions and OTC options.
Topical estrogen creams
The two main estrogen creams for vaginal dryness are Premarin and Estrace.
Premarin is only available as a brand-name medication. But GoodRx can help you access Premarin Vaginal Cream at an exclusive cash price of $249 per month. Manufacturer savings cards and patient assistance programs are also available.
Estrace, on the other hand, does have a lower-cost generic. So, it’s typically a more afforadable option.
Premarin might be linked to more side effects than Estrace — such as breast tenderness. But another study suggested no differences in side effects between Premarin and placebo (a substance without any medication).
Both Premarin and Estrace are inserted using an applicator. For exact directions, talk to your healthcare provider. How frequently you use the cream will depend on your symptoms.
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Vaginal estrogen rings
There are two main players here: Femring and Estring. Both medications provide 3 months of estrogen with one vaginal ring.
While Femring can be used for the vaginal and sexual-related symptoms of menopause, the FDA also approved this ring for other irritating menopausal symptoms — like hot flashes and night sweats. So, unlike the other vaginal estrogen products, medication from Femring is absorbed into the bloodstream — and can affect parts of the body other than the vagina.
If you only have vaginal-specific menopausal symptoms, then healthcare providers tend to go with Estring over Femring because of Estring’s localized (targeted) effects in the vaginal area. Some women may also find vaginal estrogen rings easier to use and more comfortable than other vaginal estrogen products.
Estring is expensive, but remember: 1 ring lasts for 90 days. So, you place a ring inside the vagina and remove it 3 months later.
Vaginal estrogen tablets and inserts
The main players here are: Imvexxy and Vagifem.
Imvexxy is a brand-name medication, which is available as two different strengths: 4 mcg and 10 mcg. Using clean fingers, you will place the insert into your vagina daily for 2 weeks, then twice weekly.
As for Vagifem, you will use a single-use applicator that is already pre-loaded with a 10 mcg tablet. You will use this applicator to insert the tablet into your vagina with the same dosing schedule as Imvexxy.
Unlike Imvexxy, Vagifem does have generic products — like Yuvafem, which will typically be less costly than Imvexxy.
What about over-the-counter estrogen creams?
There are OTC estrogen creams for vaginal dryness and other menopausal symptoms. But these products are used differently than prescription vaginal estrogen products. To use OTC estrogen creams, you’ll typically apply the product onto your skin — like your arms. Since every product is different, carefully read the OTC packaging or container for detailed instructions.
Can estrogen cream be purchased OTC?
Yes, you can buy OTC estrogen creams without a prescription from your healthcare provider. However, you shouldn’t try to substitute OTC estrogen creams for prescription estrogen products.
If you’re looking for vaginal estrogen creams for vaginal dryness, these aren’t available for OTC purchase. In addition to vaginal estrogen creams, vaginal rings and tablets are only available as prescriptions from your healthcare provider.
Since there is limited safety and effectiveness data for OTC estrogen creams, these products might be risky. Before buying these products, talk with your healthcare provider, who can help you weigh the benefits and risks of OTC and prescription estrogen products.
Is there a natural alternative to estrogen cream?
Yes, there are natural products available.
Like OTC estrogen creams, however, they can be risky. So, before purchasing these natural medications, have a discussion with your healthcare provider.
If you’re looking for non-hormonal OTC vaginal moisturizers or lubricants, however, experts typically consider these items as first-choice for vaginal dryness. Replens and K-Y Jelly are a couple of common examples of these OTC non-hormonal vaginal products. If you have questions about these options, talk with your pharmacist or healthcare provider.
The bottom line
When you go through menopause, your symptoms will vary. For women with vaginal-specific and sexual-related symptoms, there are first-line non-hormonal OTC vaginal moisturiziers and lubricants. For additional relief, vaginal estrogen prescriptions — like creams, rings, and tablets — are all effective choices with minimal negative effects on the uterine lining.
While OTC estrogen creams and natural products are available for purchase without a prescription, they can be risky. Consider a discussion with your healthcare provider to choose the best treatment based on your preferences.
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References
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Food and Drug Administration. (2021). Estrace cream [prescribing information].
Food and Drug Administration. (2021). Estring [prescribing information].
Food and Drug Administration. (2021). Imvexxy [prescribing information].
Food and Drug Administration. (2021). Yuvafem [prescribing information].
Lindahl, S. (2014). Reviewing the options for local estrogen treatment of vaginal atrophy. International Journal of Women’s Health.
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