Menopause and vaginal dryness

Q: I have been having perimenopausal symptoms for the past year (weight gain, hot flashes, etc.) but nothing I can’t live with. The real problem is dryness during intercourse. I am uncomfortable with the idea of taking hormones, but I’d like to do something about this problem if I can. Do you know of any natural treatments that can help? (I have tried lubricants and they work O.K. but I’d rather not resort to that if I don’t have to.) Thanks for any suggestions.

A: In making your decision about hormone replacement therapy, it is important to evaluate not only your menopausal symptoms but your risk of osteoporosis and heart disease. Please remember that just because a symptom improves, either with herbs or with time or whatever, doesn’t mean that your bone density is remaining stable or your cholesterol is O.K. These risks need to be evaluated by a professional and then options including diet, exercise, supplements, herbs, natural hormones and conventional hormones can be selected–depending on your individual situation, including risk factors.

Regarding vaginal dryness, there are a number of natural treatments that many women find helpful. One is a standardized extract of the herb black cohosh (available in natural food stores). This product has proven effective in relieving vaginal dryness after about one to two months. Vitamin E suppositories can affect the vaginal tissue as well. They’re messy, but some women swear by them. The usual method is to insert one capsule into the vagina every night for one month, and then one capsule one to three times per week. If these remedies don’t help, you may need natural estrogen/progesterone intravaginal applications (you’ll need a prescription) or maybe even conventional hormones if the problem continues to progress.

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