Menopausal Vaginal Dryness

Who Is This Service For?

This service is suitable if you are :

  • A women aged 45 years or more
  • Experiencing menopausal related vaginal dryness 
  • Requesting a prescription for Vagifem 

Please note, you may still be able to avail of this service even if you are using oral HRT (hormonal replacement therapy) and have symptoms. 

This service is NOT suitable for you if:

  • You are male
  • You are under 45 years of age
  • You are requesting this treatment for another person (that is a person other than the named person on this account)
  • You are pregnant (or suspect you could be pregnant) or breastfeeding 
  • You have experienced unusual/ unexplained vaginal bleeding in the past 12 months and have NOT been fully assessed by your doctor and given a diagnosis for this (a reason for the bleeding)
  • You have increased vaginal discharge and have not been examined by a doctor 
  • If you have a history of, or you are currently being treated for:
    • Breast cancer
    • Ovarian cancer
    • Endometrial (womb) cancer 

How Does It Work?

  • Online consultations with Irish based doctors
  • Our doctors issue a prescription if medically safe and suitable
  • Valid in any Irish pharmacy to buy your medication
  • Prescription sent to your chosen pharmacy via secure email (Healthmail) within minutes of approval

The accuracy of the information you provide is very important for the safe prescribing of the most suitable type of medication.  The information that you provide is treated with the same patient-doctor confidentiality as in a normal face-to-face consultation.

The tissues of the vagina are very sensitive to the female hormone oestrogen. This keeps these tissues moist and elastic. It also stimulates the production of glycogen. This helps to regulate the natural vaginal bacteria and protects against infections. 

As oestrogen levels fall, especially around the time of the peri-menopause/ menopause, changes to these tissues occur that can lead to uncomfortable vaginal & genital symptoms. These symptoms can persist long after menopause and are very common. Unfortunately, this is not something that is frequently discussed and, as a result is, underdiagnosed and undertreated. 

SYMPTOMS 

The vaginal tissues do not produce as many natural secretions (to lubricate and protect the vagina) when the levels of oestrogen are low and the tissues can become dry, leading to soreness, burning and itch. 

Lower levels of oestrogen alter the natural vaginal bacteria, which can lead to infections such as thrush and bacterial vaginosis.

Vaginal discharge can decrease (reduced natural secretions as described above) or increase, which is usually a later sign of vaginal dryness where the tissues are so dry and fragile that secretions leak through the thinning vaginal walls. This is normal, but it is best to attend for examination to ensure that infection is excluded before any treatment is commenced. 

Decreased oestrogen levels also lead to thinning and weakening of the tissues in the pelvic floor, so the muscles that support the bladder and the urethra are more lax leading to urinary symptoms. 

  • Vaginal dryness
  • Pain and discomfort during vaginal sex, discomfort when active/ moving and when having your smear test. 
  • Vaginal soreness/ burning and itch
  • Increased incidence of vaginal infections 
  • Increased vaginal secretions
  • Urinary problems
    • Lack of bladder control (frequency, urgency)
    • Recurrent urine infections or the sensation of a urine infection (despite negative urine tests) 

IMPACT OF SYMPTOMS

These symptoms can be very debilitating and distressing for many women. They can have a negative impact on relationships, daily activities and overall quality of life. 

TREATMENT 

The main aim of treatment is to relieve symptoms. 

Systemic hormonal replacement therapy (HRT) such as patches, gels or tablets can help to control multiple symptoms of menopause, including vaginal dryness. However, in some women additional vaginal oestrogen is all that is required to appropriately control vaginal specific symptoms. This can also be used with systemic HRT preparations if more localised treatment is needed. 

As these symptoms are caused by a lack of oestrogen in the vaginal tissues, locally replacing this oestrogen can be very effective. 

If clinically appropriate, we can provide a prescription for Vagifem treatment.

We are not able to offer prescriptions for other hormonal treatments via this service.

What is Vagifem?

Vagifem is a vaginal tablet (pessary) that contains 10 mcg oestradiol (a type of oestrogen) to help treat local vaginal symptoms associated with hormonal changes related to menopause. 

Please be aware that this medication will not help with more generalised menopausal symptoms ( eg hot flushes, night sweats, mood problems)

It is a type of HRT but it is considered to be very safe as it only acts on the vaginal tissues and contains a very low dose of hormone; using 10mcg vagifem pessaries for one year is equivalent to one 1mg oestradiol HRT tablet (one oral oestrogen HRT tablet). 

When using vagifem ,the level of oestrogen in the blood is actually the same as menopausal women who are not using vaginal oestrogen, and so there is a significantly lower risk of concerning side effects such as breast cancer, blood clots and heart disease compared with other oestrogen treatments (oral HRT & combined contraceptive pill).

How do you use it?

Vaginal tablets are easy to use. They come with an applicator and a set of instructions to guide you. 

You insert one tablet into the vagina every night for two weeks, and then twice weekly after this. There is an applicator to help with correct insertion of the pessary/ tablet.

A prescription is for 24 vaginal tablets (one packet).

How long can I use this treatment?

This can vary from patient to patient and it may take 8-12 weeks for maximum benefit to be achieved. 

You should complete an initial course of treatment (every night for 14 nights, then twice weekly for the remainder of the packet) and arrange a review.

You can stop it after this if you feel better, but often symptoms return. If this happens you can continue to use this treatment long term.

It is very important to let any doctor treating you know that you are using this medication so that your risk can be reassessed if anything significant changes in your medical history.

If your symptoms do not improve, worsen or change during this time then you should arrange a review with a doctor for a physical examination. 

Please note if you develop any unexpected/ unexplained vaginal bleeding when using this treatment at any time, you should arrange an assessment with your doctor as a priority. 

Side effects

The most common side effects of Vagifem are:

  • Vaginal discomfort
  • Vaginal bleeding/ discharge
  • Headache
  • Stomach pain 

Risks 

It is important to note that you should NOT use this mediation if you:

  • Are pregnant, breastfeeding or have recently given birth
  • Have a diagnosis of or have been treated for:
    • Breast cancer
    • Ovarian cancer
    • Endometrial (womb) cancer 

If you have had any unexpected/ unexplained vaginal bleeding in the past 12 months, you should not make a decision about using this treatment until this has been investigated and a cause has been identified. This is because this treatment may settle or mask the symptoms of a potentially serious cause of the bleeding.

 Please be aware that the patient information leaflet for this product contains out of date information. Many of the side effects and risks listed relate to oral oestrogen treatments and not to topical treatments which are very low risk. It is considered safe to take long term vaginal oestrogen products, and some women may need to use this long term to manage their symptoms. 

General Advice

To help with symptoms of vaginal dryness:

  • Avoid vaginal douching
  • Avoid tight fitting clothing
  • Wear cotton underwear
  • Check the products you are using. The following can contain vaginal irritants that will make symptoms worse: Perfumes, soaps, powders, deodorants, panty liners, spermicides and some vaginal lubricants
  • Vaginal moisturisers used on a regular basis can provide symptom relief, vaginal lubricants are intended for use during penetrative sexual activity. Both can be used with topical oestrogen treatments such as vagifem but should be used at different times.

For further information about this treatment there are links below to some useful and reliable websites. 

Please note that some of the products discussed are not available via our service and you should speak with a doctor directly if you have any questions about these. 

https://patient.info/womens-health/menopause/vaginal-dryness-atrophic-vaginitis 

https://www.balance-menopause.com/ 

https://www.uptodate.com/contents/vaginal-dryness-beyond-the-basics