Dryness and discomfort don't have to last.
Vaginal dryness, painful sex, bladder urgency and repeat infections are some of the most common changes after menopause, and some of the least talked about. They're very treatable, and you won't be the first person to bring them up with us.
- Same clinicians every visit
- Bridgewater, Nutley & telehealth statewide
- Just about every insurance, including Medicaid
What's happening, and why it matters
Low estrogen thins the tissue of the vagina, vulva and bladder. Doctors call the result genitourinary syndrome of menopause. Unlike hot flashes, it usually gets worse over time without treatment.
Dryness & irritation
Itching, burning or a feeling of rawness, even when you're not having sex.
Painful sex
Discomfort or pain that can make intimacy something to avoid rather than enjoy.
Urgency & leaking
Needing to go more often or more urgently, or leaking when you cough, laugh or exercise.
Repeat UTIs
Bladder infections that keep coming back, sometimes several a year.
Treatment options
Most women do well with one of the first three. We start with what fits your symptoms and history.
Moisturizers & lubricants
Vaginal moisturizers used a few times a week, and a good lubricant during sex. Enough for mild symptoms, and the first step for women who avoid hormones.
Low-dose vaginal estrogen
A cream, a small insert or a soft ring. It restores the tissue directly, with very little reaching the rest of the body, and you don't need progesterone with it. The most effective treatment for most women.
Vaginal DHEA
A nightly insert that the tissue converts into small amounts of estrogen and testosterone locally. An alternative to vaginal estrogen, especially for painful sex.
Ospemifene
A daily pill that acts like estrogen on vaginal tissue. An option for painful sex in women who would rather not use a vaginal product.
Pelvic floor physical therapy
For leaking, pelvic pain or muscles that tighten during sex. We refer you to a pelvic floor therapist and coordinate your care.
Whole-body hormone therapy
If you also have hot flashes or night sweats, systemic hormone therapy treats these symptoms too, sometimes with vaginal estrogen added. Hormone therapy
It's a medical problem, with a medical fix.
Most new patients are seen within a week, in person in Bridgewater or Nutley, or by video anywhere in New Jersey.
Bladder health and UTIs
The bladder and urethra respond to estrogen too. After menopause, many women notice urgency, getting up at night or leaking, and some start getting urinary tract infections again and again.
For repeat infections, vaginal estrogen lowers the chance of them coming back. For urgency and leaking, options include pelvic floor therapy, bladder training, medicine and vaginal estrogen. As your primary-care practice we can also look for other causes, such as diabetes or medication side effects.
After breast cancer
Vaginal symptoms can be especially severe after breast cancer treatment, particularly with aromatase inhibitors. We start with non-hormonal moisturizers, lubricants and pelvic floor therapy.
If those aren't enough, low-dose vaginal estrogen or DHEA may still be options. We make that decision together with your oncologist.
What a visit looks like
Many of these symptoms can be discussed and treated after a video visit. If an exam would help, it's done in our Bridgewater or Nutley office, usually by the clinician you already know. We'll ask about sexual health directly and without judgment, because most women won't bring it up on their own.
We're also honest about what doesn't work. Vaginal laser treatments are heavily marketed, but they haven't been shown to be safe and effective in good long-term studies, and the FDA has warned against using them for these symptoms.
Call us promptly about
- Any bleeding after your periods have stopped for a year
- Burning with urination plus fever or back pain
- A new lump, sore or change in the skin of the vulva
These are usually from something harmless, but they should be checked.
Vaginal and bladder health questions
Is vaginal dryness after menopause normal?
It's very common, affecting about half of postmenopausal women or more, but you don't have to live with it. Unlike hot flashes, it usually gets worse over time without treatment, and it responds well to treatment at any age.
Is vaginal estrogen safe?
For most women, yes. Low-dose vaginal estrogen acts mainly on the vaginal and bladder tissue, with very little reaching the rest of the body. You don't need to take progesterone with it, and it can often be used by women who can't take other hormone therapy.
Can I use vaginal estrogen if I've had breast cancer?
We start with non-hormonal moisturizers and lubricants. If those aren't enough, low-dose vaginal estrogen may still be an option, decided together with your oncologist.
Can vaginal estrogen prevent UTIs?
Yes. For postmenopausal women who get repeated urinary tract infections, vaginal estrogen lowers the chance of the infections coming back.
How long does vaginal estrogen take to work?
Many women notice improvement within a few weeks, with the full effect after about two to three months. It keeps working as long as you use it, usually twice a week once you're past the first few weeks.
What about laser treatment for vaginal dryness?
Vaginal laser treatments are heavily marketed, but they haven't been shown to be safe and effective in good long-term studies, and the FDA has warned against using them for these symptoms. We recommend treatments with proven results.
Should I worry about bleeding after menopause?
Any vaginal bleeding after your periods have stopped for a year should be checked. Most of the time the cause is harmless, such as thin, dry tissue, but it's important to rule out other causes. Call us and we'll see you promptly.
- The 2020 Genitourinary Syndrome of Menopause Position Statement of The North American Menopause Society. Menopause 2020;27(9):976–992.
- The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause 2022;29(7):767–794.
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