With the significant drop in estrogen after menopause, the membranes of the vagina thin, lose elasticity, and decrease their production of lubricating fluids. Sexual intercourse may be uncomfortable or even painful. Pain with intercourse may be largely a result of soreness of the vulva, the area right outside your vagina. Try avoiding harsh soaps or using a barrier cream like Eucerin or Bag Balm.
Many women find that Replens or other lubricants help ease vaginal dryness. Replens is designed to moisturize the walls of the vagina, but it may not in fact be the best lubricant. It's expensive, and it tends to drip out of the vagina. If you need a lubricant, you may want to try Astroglide or Moist Again.
You can also get yeast infections—a common side effect of antibiotics, steroids, and some chemotherapies—inside the folds of the vagina and vulva that cause discomfort, thick white discharge, and odor. Clean the area gently. You may need to use yeast-fighting creams or pills, sold over the counter or by prescription (Monistat, Terazol, Diflucan). Lotrisone, a combination anti-yeast and steroid medication, can ease the vulvar burning that can go along with a yeast infection.
Troubling vaginal discharge can also occur with menopause. Of the women taking tamoxifen, 80% will have no change in vaginal symptoms, 10% will have vaginal dryness, and 10% will have vaginal discharge. Describing your symptoms clearly and accurately to your gynecologist will make it a lot easier for you to get help.
Vaginal estrogen preparations
If you've had no improvement with your vaginal discomfort despite the use of these various remedies, talk to your doctor about using a low-dose vaginal estrogen cream or Estring (a plastic ring filled with estrogen that is inserted into the vagina). A vaginal estrogen treatment can help thicken and lubricate the walls of the vagina, but with some absorption through the walls into the blood.
Estradiol is thought to be readily absorbed, estrone less readily absorbed, and estriol minimally absorbed. There is little information about this, however. Some studies suggest that estriol may have less potent effects on breast tissue than estradiol.
If you and your doctor decide it's okay for you to use a vaginal estrogen cream for vaginal dryness and pain, you may need only a very small amount. Your doctor might start you with a dose as low as 0.1 milligram of estrogen per day, applying just a small dab inside the vagina, for up to three to four weeks, and then cutting back to once or twice a week.