For some women, vaginal symptoms such as dryness, itchiness and painful intercourse are the most bothersome. The options available include:
- General measures: Use of cotton underwear, avoiding tight-fitting underwear, use of low-allergenic washing products, avoidance of scented pads and tampons, use of plain water and avoiding soap for washing the genital area and stopping smoking.
- Dilute bicarbonate of soda washes (half teaspoon of bicarbonate of soda in 1 litre of water).
- Vitamin E may be beneficial
- Non-hormonal vaginal moisturisers (e.g. Replens®)
- Water or silicone-based lubricants for sexual activity
- Vaginal oestrogen (pessaries or creams e.g. Ovestin and Vagifem). It is not necessary to use progesterone if vaginal oestrogen alone is being used.
- If vaginal symptoms do not improve with systemic use of MHT (i.e. in tablet and patch form), adding vaginal oestrogen is often effective.
- Ospemifene. This belongs to the groups of drugs known as Selective Estrogen Receptor Modulators (SERMs).