They can pry my vaginal estrogen cream from my cold dead hands. It causes me a lot of sadness and anger to think of women around the world suffering without this easy effective treatment. I pay 30.00 for a tube and that’s with “good” insurance here in the US. Why not completely covered like Viagra often is.
Thanks so much for your work and getting me to finally realize something could be done about my post-menopausal discomfort. Just received my first prescription for estradiol vaginal tablets and am really hoping it helps. Just a heads up that my cost for a 90 day supply (42 tablets) was over $400.00! I was not expecting it to be so pricey. I am hoping that the cream is cheaper, in which case I will switch for my next prescription.
I did try to research, but had some trouble finding the correct product. Now that I know to look for Yuvafem I see I could have saved quite a bit at Cost Plus and even more at Good RX. Our system sure sucks! (And it still seems like a lot for something that isn't exactly groundbreaking.)
I use GoodRX exclusively for Vagifem tablet inserts. I pay approx. $68 for 20 inserts. Hope you are able to find the most cost effective option in your area. After a few weeks, I had total relief. Makes me angry that I had to wait so many years in pain to find the solution on my own!
Another satisfied estrogen cream user here! I had constant bladder and skin discomfort and was told by a urologist I had Interstitial Cystitis and put on a very restrictive diet. Nothing I ate or didn't eat made a difference. Went to a new doc and she immediately prescribed estrogen cream. After about 3 months I stopped having most of the bladder symptoms. Was happy to find out I can get it quite cheap from Amazon Prime Pharmacy. It was actually cheaper there without insurance than with insurance at my local chain pharmacy.
I'm seeing similar issues with transmen who want to use their vaginas, but are leery of adding estrogen of any kind. Any suggestions? Would DHEA be a better choice?
Testosterone produces an inflammatory vaginitis that is not unlike GSM and of course if their ovaries are suppressed by testosterone or they have had a bilateral oophorectomy that adds GSM on top of it. The symptoms respond very well to estrogen. Many like the ring because they can just place it and not think about it. The estrogen isn't absorbed. For those who are opposed to the idea of estrogen, then vaginal DHEA is the way to go.
My doctor prescribed Osphena and if only for the fact I don't feel like a shriveled crotch prune, it is worth the side effect of hot flashes. I swear the first few weeks my tissues were singing about the return of moisture as they transformed.
Thank you so much. I have been wanting this information for a long time and really appreciate your detailed article. I am thrilled that you plan to write about vaginal estrogens and other products too.
I have a question. Do prescription and non prescription vaginal treatments just treat the vagina?
You say "Vaginal estrogen therapy is considered the gold standard and is by far the most well-studied. It works by increasing glycogen in the vaginal tissues..." Does it just effect the vagina or does it also help with dryness in the vulva and labia etc?
Estrogen also works on the labia minora if there is dryness or symptoms there. The effect is via increasing blood flow and collagen and probably other effects as well.
I’ve seen several sources (including NAMS) that say the safety of vaginal estrogen has not been studied for longer than one year of use. How do we know it’s safe to keep using it indefinitely?
Do you see any collagen disorder patients such as OI, EDS, Marfan’s, Stickler’s? If you do, do you see differences in how they go through menopause and how do you treat it differently? Thank you for including references and diagrams re collagen. What about autoimmune diseases? Where do you practice? Thanks!
When you do your deeper dive into the various forms of vaginal estrogen treatments, could you include Estragyn cream? It is estrone, and I did not see it mentioned in this post. Thanks.
Thank you! Very informative article, as always. My question - is it okay to do both estradiol patch and vaginal conjugated estrogen cream at the same time?
You can, but it depends on the dose of the estradiol patch if you really need it, but many people on the 25 mcg patch and 25% on the 50 mcg patch will.
my question as well as the chart does list that the vaginal estrogen does not impact the exterior tissue. collagen is lost everywhere when through the transition and post menopause.
Help! Not sure where to post. I developed blood clots in both lungs a year ago (16 years of birth control pills, mostly to manage endometriosis, and three weeks after I contracted COVID for the first time.) My symptoms over the last year have been horrible (almost debilitating), but I can't touch estrogen now. Two doctors have dismissed my symptoms, telling me to do more yoga. What are any possible treatments for us who can't have estrogen?
Why doesn't vaginal estrogen therapy come with several disposable applicators? Why always wash out the same one? Wondering if there's a medical reason.
Sex question here! I use premarin vaginal cream twice a week. How long after using it should I avoid oral sex? Is two days long enough to avoid exposing my husband to it?
This is so helpful. I'm 57 and 5 years into menopause. So many symptoms that I never knew were menopausal related & my doctor has passed them off as "part of getting old & you'll just have to get used to it". Now that I'm learning more from you and others, I've been able to advocate for myself and getting treatment. I've only been on a 25 mcg patch for 3 months. Seeing improvements on many of the minor issues but no impact on the big guns that have plagued me the past 4 years - massive weight gain (not slowing down & all efforts are failing) and the urinary issues (urgency, frequency, and leaking I'm unaware is happening). The heavier I get the worse the urinary problems are. From what I understand estrogen won't help with the weight but sometimes can help with the urinary issues. Is it worthwhile upping my patch's dosage? Or adding vaginal cream? Or is this a visit to the urologist? I'm hesitant on using cream as I've always had a problem with creams being absorbed and the mess being worse than the treatment. My doctor would like me to avoid oral pills as we're watching some liver issues.
Estrogen in a patch will not help incontinence or weight gain. Oral is no better than transdermal, so if you have liver issues your doctor is right to want you to stay on the patch. If you have bladder issues a urogynecologist can probably advise you if local estrogen would help, pelvic floor physical therapy, an incontinence support device, injections, or surgery. There are lots of options depending on the type of incontinence, severity, and what feels right to you for treatment.
They can pry my vaginal estrogen cream from my cold dead hands. It causes me a lot of sadness and anger to think of women around the world suffering without this easy effective treatment. I pay 30.00 for a tube and that’s with “good” insurance here in the US. Why not completely covered like Viagra often is.
Thanks so much for your work and getting me to finally realize something could be done about my post-menopausal discomfort. Just received my first prescription for estradiol vaginal tablets and am really hoping it helps. Just a heads up that my cost for a 90 day supply (42 tablets) was over $400.00! I was not expecting it to be so pricey. I am hoping that the cream is cheaper, in which case I will switch for my next prescription.
If you are in the U.S. check out the prices at Cost Plus Drugs https://costplusdrugs.com/medications/estradiol-10mcg-vaginaltablet8pack/
I did try to research, but had some trouble finding the correct product. Now that I know to look for Yuvafem I see I could have saved quite a bit at Cost Plus and even more at Good RX. Our system sure sucks! (And it still seems like a lot for something that isn't exactly groundbreaking.)
I use GoodRX exclusively for Vagifem tablet inserts. I pay approx. $68 for 20 inserts. Hope you are able to find the most cost effective option in your area. After a few weeks, I had total relief. Makes me angry that I had to wait so many years in pain to find the solution on my own!
Another satisfied estrogen cream user here! I had constant bladder and skin discomfort and was told by a urologist I had Interstitial Cystitis and put on a very restrictive diet. Nothing I ate or didn't eat made a difference. Went to a new doc and she immediately prescribed estrogen cream. After about 3 months I stopped having most of the bladder symptoms. Was happy to find out I can get it quite cheap from Amazon Prime Pharmacy. It was actually cheaper there without insurance than with insurance at my local chain pharmacy.
I'm seeing similar issues with transmen who want to use their vaginas, but are leery of adding estrogen of any kind. Any suggestions? Would DHEA be a better choice?
Testosterone produces an inflammatory vaginitis that is not unlike GSM and of course if their ovaries are suppressed by testosterone or they have had a bilateral oophorectomy that adds GSM on top of it. The symptoms respond very well to estrogen. Many like the ring because they can just place it and not think about it. The estrogen isn't absorbed. For those who are opposed to the idea of estrogen, then vaginal DHEA is the way to go.
Thank you! My patients will thank you, too!
My doctor prescribed Osphena and if only for the fact I don't feel like a shriveled crotch prune, it is worth the side effect of hot flashes. I swear the first few weeks my tissues were singing about the return of moisture as they transformed.
Great to hear
Since I am relatively new to this blog, I'd like to know if you have written about urinary incontinence and the various treatments.
Thank you so much. I have been wanting this information for a long time and really appreciate your detailed article. I am thrilled that you plan to write about vaginal estrogens and other products too.
I have a question. Do prescription and non prescription vaginal treatments just treat the vagina?
You say "Vaginal estrogen therapy is considered the gold standard and is by far the most well-studied. It works by increasing glycogen in the vaginal tissues..." Does it just effect the vagina or does it also help with dryness in the vulva and labia etc?
Thanks,
SH
.
Estrogen also works on the labia minora if there is dryness or symptoms there. The effect is via increasing blood flow and collagen and probably other effects as well.
I’ve seen several sources (including NAMS) that say the safety of vaginal estrogen has not been studied for longer than one year of use. How do we know it’s safe to keep using it indefinitely?
I’m in my 70’s and until I read your book I didn’t know what was going on and why I was so itchy.
I am so glad it helped
Do you see any collagen disorder patients such as OI, EDS, Marfan’s, Stickler’s? If you do, do you see differences in how they go through menopause and how do you treat it differently? Thank you for including references and diagrams re collagen. What about autoimmune diseases? Where do you practice? Thanks!
When you do your deeper dive into the various forms of vaginal estrogen treatments, could you include Estragyn cream? It is estrone, and I did not see it mentioned in this post. Thanks.
Estragyn is not available in the United States so I don't have any experience with it, but I can see what is available in the literature.
Thanks, this is my question as well!
Thank you! Very informative article, as always. My question - is it okay to do both estradiol patch and vaginal conjugated estrogen cream at the same time?
You can, but it depends on the dose of the estradiol patch if you really need it, but many people on the 25 mcg patch and 25% on the 50 mcg patch will.
my question as well as the chart does list that the vaginal estrogen does not impact the exterior tissue. collagen is lost everywhere when through the transition and post menopause.
Help! Not sure where to post. I developed blood clots in both lungs a year ago (16 years of birth control pills, mostly to manage endometriosis, and three weeks after I contracted COVID for the first time.) My symptoms over the last year have been horrible (almost debilitating), but I can't touch estrogen now. Two doctors have dismissed my symptoms, telling me to do more yoga. What are any possible treatments for us who can't have estrogen?
Why doesn't vaginal estrogen therapy come with several disposable applicators? Why always wash out the same one? Wondering if there's a medical reason.
That is a manufacturer question, but it is almost certainly due to cost. I will be addressing applicator issues in the post I am working on now.
Sex question here! I use premarin vaginal cream twice a week. How long after using it should I avoid oral sex? Is two days long enough to avoid exposing my husband to it?
There isn't much data. I usually tell people one day if you are using the standard dose https://vajenda.substack.com/p/can-vaginal-estrogen-affect-your
This is so helpful. I'm 57 and 5 years into menopause. So many symptoms that I never knew were menopausal related & my doctor has passed them off as "part of getting old & you'll just have to get used to it". Now that I'm learning more from you and others, I've been able to advocate for myself and getting treatment. I've only been on a 25 mcg patch for 3 months. Seeing improvements on many of the minor issues but no impact on the big guns that have plagued me the past 4 years - massive weight gain (not slowing down & all efforts are failing) and the urinary issues (urgency, frequency, and leaking I'm unaware is happening). The heavier I get the worse the urinary problems are. From what I understand estrogen won't help with the weight but sometimes can help with the urinary issues. Is it worthwhile upping my patch's dosage? Or adding vaginal cream? Or is this a visit to the urologist? I'm hesitant on using cream as I've always had a problem with creams being absorbed and the mess being worse than the treatment. My doctor would like me to avoid oral pills as we're watching some liver issues.
Estrogen in a patch will not help incontinence or weight gain. Oral is no better than transdermal, so if you have liver issues your doctor is right to want you to stay on the patch. If you have bladder issues a urogynecologist can probably advise you if local estrogen would help, pelvic floor physical therapy, an incontinence support device, injections, or surgery. There are lots of options depending on the type of incontinence, severity, and what feels right to you for treatment.