Vaginal Atrophy Treatment Guidelines

First-Line Treatment Options

The American College of Obstetricians and Gynecologists recommends regular use of vaginal moisturizers to provide daily maintenance of vaginal tissue health and relieve dryness and discomfort in women with vaginal atrophy 1, 2
Water-based lubricants are recommended during sexual activity to reduce friction and discomfort in women with vaginal atrophy 2
Silicone-based lubricants may be more effective as they last longer than water-based products in women with vaginal atrophy 2
Topical vitamin D or E can provide additional symptom relief for vaginal dryness in women with vaginal atrophy 1, 2

Pelvic floor physical therapy can significantly improve sexual pain, arousal, lubrication, and overall satisfaction in women with vaginal atrophy 1, 2
Vaginal dilators benefit women experiencing pain during sexual activity and those with vaginal stenosis due to vaginal atrophy 1, 2

Vaginal estrogen therapy is the most effective treatment when non-hormonal options fail in women with vaginal atrophy 1
Low-dose formulations of vaginal estrogen minimize systemic absorption while effectively treating symptoms in women with vaginal atrophy 1
DHEA (prasterone) is FDA-approved for vaginal dryness and pain with sexual activity in women with vaginal atrophy 1, 2
Ospemifene, an FDA-approved selective estrogen receptor modulator (SERM), effectively treats vaginal dryness in postmenopausal women without a history of estrogen-dependent cancers 1

For breast cancer survivors, non-hormonal options should be tried first to manage vaginal atrophy symptoms 1, 2
Women on aromatase inhibitors should generally avoid vaginal estrogen as it may increase circulating estradiol 1
Estriol-containing preparations may be preferable for women with hormone-sensitive cancers as estriol is a weaker estrogen that cannot be converted to estradiol 1
Hormone-replacement therapy is no longer indicated for management of vaginal atrophy due to increased risks of breast cancer, heart attack, and stroke 3
Ospemifene is contraindicated in survivors with a history of estrogen-dependent cancers 3, 4
Incomplete treatment may lead to worsening symptoms and reduced quality of life in women with vaginal atrophy 1