I received this email from a woman suffering with vaginal dryness.

Hi Maureen,

I am hoping you can help me. I am 52 years old and going through menopause. Hot flashes have not really bothered me at all, it’s all about vaginal atrophy and my dryness is so bad, sex is painful. I have tried Gynatrof and it seemed to work for the 7 days, then when I stopped to taking it daily and went down to 2x per week as per the directions, my symptoms came back.

I went to my doctor and she suggested I take Vagifem but I have read lots about the side effects like cancer etc and now I’m not sure. I don’t want HRT, which I guess this is.

Any suggestions on what will work? I am lost on what I should take. I am thinking about going natural and using something like “menosense” or “menosmart”. Are these any good or a waste of money?


All dried up Debbie

Hi Debbie,

Thank you for your note. Vaginal dryness is the hallmark symptom of Vaginal Atrophy which is more accurately called Genitourinary Syndrome of Menopause or GSM. They symptoms of GSM are vaginal dryness, burning, itching, thin watery discharge, painful sex, post-coital bleeding and recurrent bladder infections with GSM. Gynatrof takes 2 months to optimize and since it is hormone-free, you can take more frequently even daily if you like. You can also use it during sex.

If you are experiencing symptoms of GSM, it is best treated with low dose localized estrogen therapy such as Vagifem. Vagifem is NOT HRT or Hormone Replacement Therapy which is more accurately described as Hormone Therapy which is the treatment for vasomotor symptoms of menopause such as night sweats, hot flashes and leg pains. Vagifem is low dose topical hormone therapy for vaginal atrophy or GSM. Vagifem is the lowest form of estrogen. The reason that the package insert warns about cancer is because it contains estrogen even though it is such a small amount. It is a regulation requirement that scares off a lot of women.

To be honest, those risks don’t apply and it should be changed. Vagifem also takes 2-3 months to optimize after taking it daily for two weeks, then twice weekly on a Monday and Thursday typically at night. The company that manufactures Vagifem, in the interest of making it the low dose of estrogen that it is, reduced the amount of estrogen from 25 micrograms (mcg) per tablet to 10 mcg per tablet so it’s not uncommon that that dose is now too low for many women. Some women have to take it three – four times a week as prescribed by their doctors.

Do not waste your money on menosense or menosmart. They do not work. End of story.

There are other low dose localized estrogen therapies: premarin cream and/or estragyn cream. There’s also a ring known as an “estring” that contains estrogen, that is left in place for three months, continuously delivering estrogen to your vaginal tissues. At the end of three months, the estring is removed and a new one is inserted by your doctor, Nurse Practitioner or Nurse Continence Advisor.

As for other hormone-free options, there is Repagyn a vaginal suppository which can be ordered online at www.repagyn.ca

There is also now a new laser therapy called the Mona Lisa Touch that we are offering in our clinic which is hormone-free and takes five minutes. Three treatments every six weeks is recommended to restore a woman’s vagina to her pre-menopausal state, often stopping light bladder leakage as well. .
One more point. Vaginal dryness/GSM is the one symptom/condition of menopause that doesn’t go away. Whatever treatment you use is lifelong therapy. Please let me know if you require anything further.

Hope that helps,


Maureen McGrath is a women’s health expert and hosts the Sunday Night Sex Show on News Talk 980 CKNW. She is creator of the blog 50ShadesofPink.ca and has a clinical practice in North Vancouver, British Columbia. For more information about Mona Lisa Touch, visit Mona Lisa Touch

Maureen McGrath

Maureen McGrath

Host of the CKNW Sunday Night Health Show on Corus Radio. As a leading women's health expert and Registered Nurse, I understand the importance that sexual, vaginal, bladder and bowel health has on overall health and relationships.

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