Estradiol vaginal cream is a common prescription for women experiencing menopause, specifically to alleviate vaginal dryness and discomfort during intercourse. But what exactly is estradiol, and why is this cream so effective? Let’s delve into the science behind it.
Estradiol is a naturally occurring estrogen hormone produced by the ovaries during a woman’s reproductive years. It plays a vital role in various bodily functions. Estradiol stimulates the production of nitric oxide, which helps dilate blood vessels. This improved blood flow benefits several areas, including the brain (potentially reducing dementia risk), the skin (leading to softer texture), and crucially, the vagina and vulva, increasing moisture in that area.
Perhaps even more significantly, estradiol acts as a potent anti-inflammatory agent. The body can produce inflammatory proteins called cytokines, which are linked to metabolic issues such as insulin resistance, diabetes, and even cancer. Before menopause, women tend to experience these health problems less often than men. However, the decrease in estradiol levels during menopause can lead women’s health risks to become comparable to those of men. This is because chronic inflammation arises when inflammatory cytokines – such as interleukin 1 (IL-1), interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF alpha) – send signals to the nucleus via the cytoplasmic protein nuclear factor kappa B (NFK-B). This communication activates inflammatory genes, resulting in tissue inflammation.
During a woman’s reproductive years, the estradiol produced by the ovaries reduces the levels of these inflammatory cytokines and, more importantly, inhibits NFK-B from transmitting signals from cytokines to the nucleus. In addition, estradiol promotes the dominance of Lactobacillus species bacteria in the vagina, maintaining an acidic pH balance and reducing the risk of bacterial vaginosis (BV), which thrives in a more alkaline environment.
So, how does applying estradiol to the vagina address these issues?
Before menopause, the vagina, vulva, and lower bladder are rich in estradiol receptors – specific sites where estradiol can exert its effects. Estradiol promotes blood vessel dilation, enhancing moisture, softening tissues, and protecting this region from inflammation. During menopause, the decline in estradiol levels particularly impacts this area, resulting in reduced blood flow, increased dryness, and a shift towards a more alkaline pH, making it more susceptible to BV. Nerve distribution in the pelvis is also concentrated in the outer third of the vagina and vulva. Lowered estradiol can therefore contribute to inflammation that is perceived as painful intercourse.
Applying a small, pea-sized amount of estradiol vaginal cream externally can effectively reverse most of these localized menopausal symptoms. Numerous studies have shown that this localized application carries no increased risk of breast cancer.
The recommended application involves using the cream nightly for the first month, followed by a maintenance dose of three times per week. This regimen helps most women find relief from the irritation and discomfort associated with vaginal dryness.
In conclusion, estradiol vaginal cream is a safe and effective treatment option for addressing vaginal dryness, discomfort during intercourse, and other related symptoms caused by the decline in estrogen levels during menopause. It works by increasing blood flow, restoring moisture, and reducing inflammation in the vaginal area. By consulting with a healthcare professional, women can determine if estradiol vaginal cream is the right solution for their specific needs.
