Vaginal dryness treatment covers genitourinary syndrome of menopause (GSM, formerly called vulvovaginal atrophy) — thinning, drying, and inflammation of the vaginal walls due to decreased oestrogen after menopause, breast cancer treatment, or surgical ovary removal. Symptoms include burning, itching, dyspareunia (pain with intercourse), recurrent UTIs, urinary urgency, and post-coital bleeding. This is a physical tissue change, distinct from low desire or arousal disorders. The first-line treatment is local (vaginal) low-dose oestrogen.
Evalon Cream (estriol 1 mg/g vaginal cream) is the cornerstone product. Estriol is the weakest of the three natural oestrogens and is preferred for local therapy because systemic absorption is minimal — it raises serum oestradiol only marginally, so the breast and endometrial cancer concerns associated with systemic HRT do not apply at typical doses. Begin: mild improvement in 2-3 weeks, full benefit in 8-12 weeks. Schedule: 0.5 g intravaginally at bedtime daily for 2-4 weeks (induction), then 2-3 times weekly (maintenance). For dyspareunia specifically, applying a thin layer to the vulvar vestibule is also helpful. Continue indefinitely — symptoms return within weeks of stopping.
What it is not. Evalon Cream does not increase libido, will not solve arousal disorders, and will not treat psychogenic dyspareunia. It treats the physical tissue (lubrication, elasticity, pH normalisation, restoration of healthy vaginal flora). For low desire or arousal disorders see our Vrouwelijke seksuele disfunctie category.
Adjuncts that complement Evalon Cream. Non-hormonal vaginal moisturisers (Replens, Hyalo Gyn — apply 2-3 times weekly) for daily comfort. Silicone-based lubricants for intercourse (water-based for use with condoms). Vaginal dilator therapy if pelvic floor or introital tightness has developed. Pelvic floor physiotherapy.
Safety and contraindications. Avoid with active hormone-receptor-positive breast cancer unless oncology cleared. Caution in unexplained vaginal bleeding (investigate first), severe liver disease, history of oestrogen-sensitive tumours. Pregnancy is a contraindication (this is a post-menopausal product). Annual gynaecology follow-up advisable for any oestrogen therapy.
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