Vaginal moisturisers and lubricants

Vaginal moisturisers need to be used regularly and can be applied at least twice weekly. Vaginal lubricants can be used at the time of intercourse if there are insufficient vaginal secretions for comfortable sexual activity. Petroleum jelly (Vaseline) is not recommended as a lubricant and can break down the latex in condoms. Vaginal moisturisers and lubricants can be used alone or in addition to vaginal oestrogen preparations.

Vaginal oestrogen

Low dose oestrogen in the form of vaginal tablets, creams, rings or gels can be used to treat vaginal atrophy caused by oestrogen deficiency. Low dose vaginal oestrogen is recommended as first-line by NICE for vaginal and urinary symptoms, and treatment can be continued for as long as needed to relieve symptoms. Women can be advised of this approach and to discuss the option with their GP. At the time of writing the MHRA is considering an application to reclassify a vaginal oestrogen tablet preparation from prescription only to pharmacy supply.

Treatment should ideally be started early before irreversible changes have occurred and needs to be continued to maintain any benefits otherwise, when treatment is stopped, symptoms often return. A progestogen preparation is not needed for endometrial protection, as systemic absorption of low dose vaginal oestrogen is minimal. Vaginal oestrogen can be used together with HRT if needed. There is no evidence of damage to latex condoms and diaphragms.