By: Dr. Jordan Robertson ND

It’s estimated that 10-40% of menopausal women experience vaginal atrophy, dryness and pain during intercourse(1). These signs of estrogen deficiency can be easily treated, by working with one of our Naturopathic Doctors. Often other symptoms of menopause such as hot flashes abate with time, but vaginal symptoms often continue to progress without treatment, having a significant impact on quality of life of aging women(2). Even if women feel balanced elsewhere in their hormonal health, they qualify to be evaluated for hormonal support for vaginal atrophy. Estrogen deficiency causes the vaginal tissue to become weaker and more likely to be torn, bleed and ultimately causes pain.

For some women, using a personal lubricant (choose a natural lubricant – many commercial brands have endocrine disrupting chemicals that should not be applied every day) may be enough to ease pain during intercourse, and keep tissues from causing pain during sitting and walking. But for many women, the pain they feel is enough to avoid intercourse all together, and to feel discomfort for most of the day.

Our bodies produce many types of estrogen, with Estriol (E3) being the weakest form. Estriol is one of the versions of this hormone that we can prescribe safely in almost all women, given the low activity at estrogen receptors in the breast and uterus, and it’s affinity for other tissues such as vaginal membranes(3–6). Estriol applied vaginally can support vaginal atrophy and reduce pain, with as little as 1-2 applications per week. We also can recommend your Estriol be delivered in specialized creams depending on your symptoms, that offer additional healing properties beyond standard lubricants.

Women with vaginal atrophy and pain during intercourse often have other menopausal symptoms that can be addressed with our comprehensive hormone plan. Symptoms such as urinary incontinence, hot flashes, mood changes and weight gain can all be supported by one of our Doctors.


  1. North American Menopause Society. The role of local vaginal estrogen for treatment of vaginal atrophy in postmenopausal women: 2007 position statement of The North American Menopause Society. Menopause N Y N. 2007 Jun;14(3 Pt 1):355–69; quiz 370–1.
  2. Jokar A, Davari T, Asadi N, Ahmadi F, Foruhari S. Comparison of the Hyaluronic Acid Vaginal Cream and Conjugated Estrogen Used in Treatment of Vaginal Atrophy of Menopause Women: A Randomized Controlled Clinical Trial. Int J Community Based Nurs Midwifery. 2016 Jan;4(1):69–78.
  3. Buhling KJ, Eydeler U, Borregaard S, Schlegelmilch R, Suesskind M. Systemic bioavailability of estriol following single and repeated vaginal administration of 0.03 mg estriol containing pessaries. Arzneimittelforschung. 2012 Aug;62(8):378–83.
  4. Cano A, Estévez J, Usandizaga R, Gallo JL, Guinot M, Delgado JL, et al. The therapeutic effect of a new ultra low concentration estriol gel formulation (0.005% estriol vaginal gel) on symptoms and signs of postmenopausal vaginal atrophy: results from a pivotal phase III study. Menopause N Y N. 2012 Oct;19(10):1130–9.
  5. Caruso S, Cianci S, Amore FF, Ventura B, Bambili E, Spadola S, et al. Quality of life and sexual function of naturally postmenopausal women on an ultralow-concentration estriol vaginal gel. Menopause N Y N. 2016 Jan;23(1):47–54.
  6. Chuery ACS, Speck NM de G, de Moura KFQ, Belfort PN, Sakano C, Ribalta JCL. Efficacy of vaginal use of topical estriol in postmenopausal women with urogenital atrophy. Clin Exp Obstet Gynecol. 2011;38(2):143–5.