Are there any side effects to using the estrogen ring instead of the cream for vaginal atrophy? How long does the ring last? -- Sheila

The estrogen ring is a treatment for urogenital atrophy, a common problem among postmenopausal women affecting the tissues lining the vagina and urinary system. When the body's estrogen production ends at menopause, these tissues begin to shrink or atrophy. In the vagina, this leads to dryness, itching, and pain during sexual intercourse. Urinary symptoms may include pain during urination, a sudden, urgent need to urinate, and involuntary loss of urine (incontinence).

These symptoms can be treated with estrogen, taken by mouth, applied topically in creams, or via an estrogen ring (Estring) inserted deep into the vagina. My colleague Monica Stokes, MD, a gynecologist practicing in San Francisco, tells me that placed deep in the vagina, the ring time-releases 7.5 micrograms of estradiol (a natural form of estrogen) daily. The ring lasts for 90 days. It can fall out if you have to strain to move your bowels. If this happens, the manufacturer recommends rinsing it off and reinserting (probably not a good idea if the ring falls in the toilet with stool).

As far as side effects are concerned, clinical trials showed only mild and transient vaginal discomfort, irritation or abdominal pain. Of more concern to some women is whether estrogen from the ring (and the creams) can be absorbed into your bloodstream and carried elsewhere in the body. This may not be a major problem. Studies have shown that when the vaginal lining has thickened in response to the hormone, it becomes more difficult to penetrate, reducing absorption of topical estrogen into the body.

As an alternative to estrogen, you could try the nonhormonal moisturizing gel Replens (apply three times a week) if your problem is vaginal dryness. This product also helps prevent bacterial or yeast overgrowths that can cause vaginal itching. A vaginal lubricant such as Astroglide used just prior to intercourse can relieve discomfort. There is also some evidence that topical application of vitamin E to external and internal vaginal tissue can help. There may also be herbal solutions such as Chasteberry (Vitex agnus-castus) which can help eliminate many symptoms of menopause including vaginal dryness. Some women report excellent results from constitutional remedies prescribed by homeopathic physicians, so that approach may be worth a try. Be sure to drink at least eight glasses of water a day and consider adding some soy foods to your diet; a few small studies have found that soy had beneficial effects on vaginal tissues.

Dr. Andrew Weil

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