Definition: Vulvar and vaginal atrophy is the label term for changes in and around the vagina after menopause, when estrogen falls. Labels name its symptoms as vaginal dryness and pain during sex (dyspareunia). Products approved for it include vaginal estrogen (Vagifem), prasterone (Intrarosa) and ospemifene (Osphena).
| Product | Form | Approved use (short form) |
|---|---|---|
| Vagifem (estradiol) | Vaginal insert | Atrophic vaginitis due to menopause |
| Intrarosa (prasterone, DHEA) | Vaginal insert | Moderate to severe pain during sex from atrophy |
| Osphena (ospemifene) | Tablet by mouth | Moderate to severe pain during sex and vaginal dryness from atrophy |
Premarin and oral estradiol tablets are also approved for it. The Premarin label says topical vaginal products are considered when the symptoms are only vaginal.
Vagifem carries the estrogen boxed warning. Osphena, a SERM, has its own box on endometrial cancer and clots. Intrarosa has no boxed warning; its label says estrogen is a breakdown product of prasterone and that it has not been studied in women with a history of breast cancer. Before Intrarosa is considered, unexplained, persistent or recurring genital bleeding after menopause is checked for its cause.
Vaginal products often start with daily use and then drop to a few times a week, which is easy to lose track of. Logging each use and any bleeding or spotting gives your prescriber a clear history.
Read more on Dose Track: Vagifem side effects · Intrarosa side effects · Osphena side effects · Estrace cream side effects