What are the different HRT options for vaginal dryness?

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Dear Ellen,

I am experiencing vaginal dryness.  I have tried different lubes, but sadly sex still hurts.  I have an appointment with my gynecologist next week. I would like to understand the difference between the different hormone therapies before I see my doctor.   Can you help educate me on this?

                                                                                            Sorry for the last minute request,


Dear Betsy,

Some women get help with lubes and moisturizers, but others need LET (local estrogen therapy) or systemic estrogen therapy.

LET is estrogen applied directly to vaginal tissues, so it goes directly to the affected area, with minimal absorption of estrogen into the bloodstream. LET is available in creams, a ring and a tablet.

Systemic hormone therapy (HT) allows estrogen to circulate throughout the bloodstream to all parts of the body. It’s available in many forms: a pill, injection, patch, gel and spray. Systemic HT is most often prescribed for multiple whole-body symptoms of menopause, including night sweats, hot flashes, and others.

Some women need a combination of treatments.  All of the above require a prescription from your specialist. So, be sure you are going to a good menopause specialist.  I have a Menopause Specialist Directory on my website.  These specialists have been recommended by the sisterhood who have found hormone happiness!

Good Luck and keep me posted!



After struggling with her own severe menopause symptoms and doing years of research, Ellen resolved to share what she learned from experts and her own trial and error. Her goal was to replace the confusion, embarrassment, and symptoms millions of women go through–before, during, and after menopause–with the medically sound solutions she discovered. Her passion to become a “sister” and confidant to all women fueled Ellen’s first book, Shmirshky: the pursuit of hormone happiness. As a result of the overwhelming response from her burgeoning audiences and followers’ requests for empowering information they could trust, Ellen’s weekly blog, Menopause MondaysTM, was born.

  • Testosterone by injection (more effective than cream) also helps with desire and arousal, making for more slip and slide during more fun sex. As a woman who has managed provoked vestibulodynia much of my life, I also find my tissues become more sensitive right before my testosterone shot is due. For me, my testosterone part of HRT is very helpful.

    • Ellen Dolgen

      Thanks for sharing!