The loss of estrogen often causes changes in the vagina with dry, thin fragile tissues with less resistance to infection. This can lead to dryness, discomfort, irritation, discharge and sometimes slight bleeding. The outer lips can also become thin and cause discomfort even from friction on underwear. Sadly, many women put up with these symptoms in silence, often feeling too embarrassed to seek help or are unaware that treatments are available. If dryness is the main problem, vaginal moisturisers such as Replens, Sylk or Senselle can be used. To restore the tissues back to being supple, moist, sensitive and resistant to infection, then vaginal estrogen is extremely effective. This can be used in the form of vaginal tablets, pessary, cream or a ring. The tablets, pessaries and cream are applied every night for 2 weeks and then continued twice weekly, while the vaginal ring stays in place for 3 months. Because estrogen from these routes is low dose and is not absorbed significantly into the rest of the body, it can be used safely when normal HRT is not appropriate. Also, some women taking HRT find that they still have vaginal problems and it may be necessary to use vaginal estrogen in addition.
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