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  • Writer's pictureDr. Bonura


In menopause, because of the lack of production of estrogen by the ovaries, 50-85% of women will develop genitourinary syndrome. This is a chronic, progressive medical condition that affects the vagina and urogenital tissue (bladder, urethra). It causes symptoms and physical changes to your body, including genital, urinary and sexual symptoms.

Hot flashes and night sweats will get better over time, but urogenital symptoms and changes are chronic, get worse over time and frequently require treatment.

Some of the symptoms are:

  • GENITAL Symptoms: vaginal dryness, burning, itchiness, lack of lubrication, discharge.

  • URINARY Symptoms: painful urination, frequency, incontinence, recurrent urinary tract infections.

  • SEXUAL Symptoms: painful sex.

Some of the physical signs are:

  • Thinning of the labia

  • Narrowing of the vaginal opening

  • Vaginal lining becomes thin, pale, and dry

In our practice our treatment goal is to alleviate your symptoms. We can do that by the use of some over-the-counter products:

  • VAGINAL DRYNESS – moisturizers (Replens, Luvena) that will hydrate your vagina and are used at least 3 times a week.

  • PAINFUL SEX - add a lubricant (Uberlube, AstroglIde) for you and your partner to decrease the discomfort caused by friction during sex. But remember these measures do not restore the vaginal changes that were lost because of menopause.

If these over-the-counter measures do not alleviate your symptoms we offer:


  • Low-dose vaginal estrogen in cream, pill, suppository or ring form. Vaginal estrogen is safe and there is very low absorption into your circulation if placed in the lower third of your vagina.

  • Vaginal DHEA: (pre-hormone) called INTRAROSA vaginal suppositories. Approved for painful sex and vaginal dryness.

  • Pelvic floor muscle therapy – increases vaginal blood flow.

These measures will help restore those physical changes and symptoms that were lost in menopause and relieve your symptoms.


  • Lubricants used by both partners with sex

  • Vaginal low dose estrogen

  • DHEA suppositories (Intrarosa)

  • Pelvic floor muscle therapy

  • Vaginal dilators (stretch, enlarge vagina)


Incontinence, urgency, overactive bladder:

  • Pelvic Floor Muscle therapy

  • Vaginal Estrogen

Recurrent urinary tract infections (UTI) (2 or more in 6 months)

  • Vaginal Estrogen

  • Prophylactic antibiotic

Women with a history of breast cancer, especially those on medications for breast cancer who have vaginal dryness or painful sex that don’t respond to over-the-counter remedies, can be helped. We can use low dose vaginal estrogen or DHEA suppositories (Intrarosa). Recent data shows no increase in the risk of recurrence with the use of low dose vaginal estrogen. Before ordering vaginal estrogen in these patients, we always consult with their oncologist. Many oncologists allow for its usage. DHEA Suppositories (INTRAROSA) are not contraindicated in patients with a history of breast cancer.

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