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    Vaginal dryness and pain
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    An_248066 posted:
    I'm definitely menopausal and am not taking any menopausal medications. I am taking a small dosage of for mood control. I have very dry vaginal passage and burning pain during sex. Instead of estrogen replacement which affects my mood immensely, can I effect this dryness via diet? I have heard that refraining from caffeine, alcohol, sugar and/or medications might be able to alleviate the problem. Is this definitely true? I really like having coffee in morning and some wine in the evenings and would like to know if eliminating these nutrients would really work to help my situation before I give them up.
    Reply
     
    avatar
    fcl responded:
    To be honest, a good vaginal lubricant would be much more effective during sex. Does the dryness affect you at any other tiime?
     
    avatar
    Jane Harrison Hohner, RN, RNP responded:
    Dear An: I concur with FCL's comment (as usual), but I would like to add some additional information. Most estrogen replacement (eg pill/patch/gel/cream) is given in doses high enough to create a blood level of 60 or more picograms.

    There is good data about estradiol blood levels in women using vaginal estrogen products. Rioux (2000) compared the older 25 microgram Vagifem (which is being taken off the market in favor of a newer 10 microgram dose) to Premarin vaginal cream. After 24 weeks only 3/80 of the Vagifem users had an elevated estradiol of more than 40 picograms compared to 21/79 Premarin users. Mettler (1991) found blood estradiol levels of 11.2 picograms after a year of usage--this compares to 9.6 before treatment began. And that was will the higher dose Vagifem. Notelovitz (2002) found blood levels of 23 picograms after three months of use of Vagifem 25 micrograms.

    What this means is that local vaginal estrogen is designed to not have a high blood level. We do not even need to prescribe a progesterone in a woman using these low dose vaginal estrogen products. You can certainly try a good lubricant during sex, or a vaginal moisturizer (eg (Replens) to see if those will work. IF neither of these over the counter approaches work you might consider the very lowest dose Vagifem. Some women use this prescription for two week until the symptoms improve then only use it as needed (eg once a week or less). Giving up coffee and wine is worth a try but that is a quality of life issue, too!

    Yours,
    Jane


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