Sexual Wellness Resource Center
For Adults over 50.

Osphena

ASK THE DOCTOR

What do you think about Osphena? Should post menopausal women take it even if they are not sexually active? Gracias

I have to admit that I was not aware of this drug. It was approved by the FDA in 2013 for the treatment of pain with intercourse in menopausal women. What is Osphena? It is an estrogen agonist/antigonist, meaning on some tissues it acts like an estrogen and other tissues it acts like an anti estrogen. It is similar to the drug tamoxifene which is used as additional treatment in some breast cancer patients after surgical or radiation treatment because of its anti estrogen effects on the breast, a good thing for breast cancer survivors.

Osphena acts like estrogen on the vagina and the uterus. It makes the vaginal tissue thicker and less fragile resulting in less pain with intercourse, a good thing. It causes the endometrium, the lining of the uterus, to grow which eventually could cause bleeding, precancer changes or cancer of the endometrium, bad things. To prevent the bad things, it must be taken with progesterone, the balancing hormone of estrogen. That means another pill every day. It can also cause or increase the frequency and intensity of hot flashes, a bad thing for menopausal women who may already be suffering from hot flashes.

Finally, is it safe? Besides the bleeding and cancer risks discussed above, there is a very slight risk increased risk of strokes and blood clots in the legs. However, these risks also exist for women on estrogen alone hormone replacement therapy.

What do I think about Osphena? This is a medication with a lot of drawbacks and potential problems. Vaginal estrogen cream is the standard of care for the treatment of painful sex during the menopause. It is not absorbed into the bold stream, so it does not affect the lining of the uterus, nor increase the risk of stroke or blood clots. It does not require a second medication to prevent uterine cancer. It does not cause or increase hot flashes. For the majority of women vaginal estrogen cream will be the safest option with the fewest side effects.

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