For many women, the natural passage through perimenopause and into menopause brings a constellation of uncomfortable vaginal symptoms. These often include persistent dryness, itching, burning, and painful intercourse, a condition medically known as Genitourinary Syndrome of Menopause (GSM) or vaginal atrophy. While local estrogen therapy is a highly effective treatment that addresses the underlying cause, it’s not the only solution. Many women, whether due to personal preference, medical considerations, or a desire for alternative approaches, are actively seeking non-hormonal treatments. The empowering truth is that you absolutely do not have to suffer in silence! A diverse range of proven non-hormonal therapies can significantly alleviate vaginal atrophy symptoms, offering lasting relief and helping you reclaim comfort and intimate well-being. This comprehensive guide will explore these vital non-hormonal solutions, empowering you to manage your vaginal health effectively.
The Menopausal Impact: Why Vaginal Atrophy Demands Attention
Understanding the Changes and the Need for Diverse Solutions
The physiological changes that occur in the vagina during perimenopause and menopause are primarily a direct result of the natural and often significant decline in estrogen production by the ovaries. Estrogen is far more than just a reproductive hormone; it plays a critical and multifaceted role in maintaining the health, vitality, thickness, elasticity, and natural lubrication of various tissues throughout the body, most notably those in the genitourinary system – including the vagina, vulva, urethra, and bladder. These areas are densely populated with estrogen receptors, rendering them highly sensitive to its fluctuating levels.
As estrogen levels naturally diminish, these delicate tissues undergo a progressive process known as vaginal atrophy, which forms the core of the broader clinical condition termed Genitourinary Syndrome of Menopause (GSM). The impact of this estrogen deficiency manifests in a variety of uncomfortable and often disruptive ways:
- Vaginal Dryness: This is perhaps the most prevalent symptom, characterized by a persistent and often severe feeling of parchedness. This dryness can be constant, causing discomfort even during daily activities, not just during sexual encounters.
- Thinning of Vaginal Walls: The normally plump, moist, and resilient vaginal lining becomes noticeably thinner, more fragile, and loses its natural folds (rugae). This makes it highly susceptible to irritation, friction, and microscopic tears.
- Reduced Natural Lubrication: The glands responsible for producing natural vaginal moisture become significantly less active, leading directly to insufficient lubrication during arousal and persistent daily dryness.
- Loss of Elasticity and Pliability: The vaginal tissues lose their inherent ability to stretch and expand, contributing to feelings of tightness and a lack of “give.” This can make many activities uncomfortable.
- Chronic Irritation: The thinned, dry, and less elastic tissues are exquisitely vulnerable to irritation from even minor friction (e.g., from clothing, walking, or exercise), leading to persistent itching, burning, and soreness.
- Painful Intercourse (Dyspareunia): The combination of reduced lubrication and diminished elasticity makes sexual activity uncomfortable or even severely painful, often leading to avoidance of intimacy and significant strain on relationships.
- Urinary Symptoms: The decline in estrogen also directly affects the lining of the urethra and bladder, which share similar embryonic origins and estrogen dependency with the vagina. This can lead to bothersome urinary issues such as urgency, frequency, and a markedly increased susceptibility to recurrent urinary tract infections (UTIs), even in the absence of bacterial infection.
- Disrupted pH Balance: Estrogen helps maintain the acidic pH of the vagina (typically 3.8-4.5), which is crucial for supporting the growth of protective Lactobacilli bacteria. With estrogen decline, the vaginal pH can become less acidic (more alkaline), further increasing vulnerability to irritation and various types of infections.
These pervasive symptoms, while common during menopause, are not merely a “normal” or inevitable part of aging that women must silently endure. They represent a medical condition for which highly effective treatments are available.
While local estrogen therapy (delivering low doses of estrogen directly to the vaginal tissues) is widely considered the most effective medical treatment for directly reversing these underlying tissue changes, it is not always the preferred or suitable option for every woman. There are several compelling reasons why women actively seek non-hormonal therapies:
- Medical Contraindications: Certain serious medical conditions, such as a personal history of specific cancers (e.g., estrogen-receptor-positive breast cancer), a history of blood clots (deep vein thrombosis or pulmonary embolism), active liver disease, or certain types of stroke, may preclude the use of any form of hormonal therapy, even localized ones.
- Personal Preference and Philosophy: Many women simply prefer to avoid introducing exogenous hormones into their bodies, opting for more natural, non-pharmacological, or device-based approaches to managing their symptoms. This is a valid and respected personal choice.
- Insufficient Relief from Hormones: In some cases, even with the use of local estrogen, women may still experience lingering symptoms or find that additional non-hormonal support is beneficial for comprehensive relief.
- Mild to Moderate Symptoms: For those experiencing milder or intermittent symptoms of vaginal atrophy, non-hormonal options can often provide adequate and satisfying relief without the need for prescription medications.
- First-Line Approach: Many healthcare providers will initially recommend trying over-the-counter non-hormonal treatments as a first-line approach, especially for mild to moderate symptoms, before considering prescription or procedural options.
- Complementary Therapy: Even for women who are using local estrogen therapy, non-hormonal products like lubricants still play a vital complementary role in enhancing comfort, particularly during specific intimate moments.
The empowering truth is that significant advances have been made in non-hormonal therapies that can effectively manage vaginal atrophy symptoms. These options provide substantial relief, improve daily comfort, and help women reclaim their intimate well-being and overall quality of life, even when estrogen-based treatments are not an option or are not preferred.
Your First Line of Defense: Over-the-Counter Non-Hormonal Solutions
Vaginal Moisturizers and Personal Lubricants: Essential Tools for Daily Comfort and Intimacy
For women seeking to manage vaginal atrophy without estrogen, over-the-counter (OTC) vaginal moisturizers and personal lubricants represent the foundational, accessible, and often highly effective first-line treatments. Understanding their distinct roles and how to choose quality products is crucial for comprehensive relief.
1. Vaginal Moisturizers: For Lasting Daily Comfort
Vaginal moisturizers are designed for regular, consistent use to provide ongoing hydration to the vaginal tissues. They work to alleviate chronic dryness, itching, and irritation by mimicking the body’s natural moisture, improving the overall health of the vaginal lining over time. Think of them as a daily facial moisturizer, but for your sensitive vaginal area.
How They Work:
- Sustained Hydration: Quality moisturizers contain ingredients that adhere to the vaginal walls and slowly release water over several days (typically 2-3 days per application). This sustained hydration helps to rehydrate the thinned, atrophied tissues.
- Improved Tissue Health: By continuously delivering moisture, they help to improve the elasticity, plumpness, and resilience of the vaginal lining, making the tissues less fragile and reducing susceptibility to micro-tears and irritation from daily activities.
- pH Balance Support: Many effective moisturizers are pH-balanced to match the healthy acidic environment of the vagina (pH 3.8-4.5). Maintaining this optimal pH is crucial for supporting beneficial Lactobacilli bacteria, which helps protect against infections and irritation.
- Cumulative Benefits: Their positive effects build up over time. Regular use leads to significant reduction in chronic dryness, itching, and burning, improving comfort even outside of sexual activity.
What to Look For (Key Properties & Ingredients):
- Water-Based: Always choose products where purified water is the primary ingredient. Avoid petroleum-based options like Vaseline, which can trap bacteria and don’t truly hydrate.
- Hydrating Agents: Look for key ingredients like hyaluronic acid (excellent for attracting and retaining moisture) or naturally derived humectants.
- Optimal pH & Osmolality: Products should be pH-balanced and have an osmolality (concentration of particles) that is close to natural vaginal fluids (ideally below 1200 mOsm/kg) to prevent drawing water out of delicate cells.
- Free from Irritants: Avoid fragrances, dyes, parabens, warming/cooling agents, strong antiseptics (like chlorhexidine), and petroleum jelly, as these can exacerbate irritation or disrupt the vaginal microbiome.
2. Personal Lubricants: For Immediate Intimate Comfort
Personal lubricants are used on demand, specifically during sexual activity (intercourse, masturbation, or with sex toys) to reduce friction and enhance comfort and pleasure. They provide immediate slipperiness but do not offer long-term hydration or address underlying tissue health.
How They Work:
- Instant Friction Reduction: Applied just before or during intimacy, lubricants create a smooth, slick surface that minimizes discomfort and pain caused by friction on dry, atrophied tissues. This allows for more comfortable and enjoyable sexual experiences.
- Temporary Solution: Their effect is fleeting; they typically wash away or absorb after use.
What to Look For (Types & Considerations):
- Water-Based Lubricants:
- Pros: Most versatile. Safe with all condoms (latex and non-latex) and silicone sex toys. Easy to clean up, non-staining, and generally well-tolerated.
- Cons: May dry out more quickly, requiring reapplication. Again, consider glycerin content if you’re sensitive.
- Silicone-Based Lubricants:
- Pros: Very long-lasting and highly slick; waterproof. Excellent for extended intimacy.
- Cons: Crucially, do NOT use with silicone sex toys (they can degrade the toy’s material). Can leave a slick residue and may be harder to clean.
- Oil-Based Lubricants (Use with Extreme Caution):
- Pros: Long-lasting.
- Cons: Absolutely NOT safe with latex condoms (causes breakdown). Can disrupt vaginal pH, potentially increasing infection risk. Generally NOT recommended for internal vaginal use.
- pH & Osmolality: Like moisturizers, opting for pH-balanced and ideally iso-osmolar or slightly hypo-osmolar lubricants is best for maintaining vaginal health during intimacy.
- Free from Irritants: Avoid fragrances, dyes, parabens, and warming/tingling agents.
The Synergistic Approach: For most effective non-hormonal management of vaginal atrophy, the best strategy involves using both a vaginal moisturizer regularly to improve overall tissue health and a lubricant during intimacy for immediate comfort. This dual approach comprehensively addresses both chronic daily symptoms and situational needs.
Beyond Over-the-Counter: Advanced Non-Hormonal Therapies
Prescription Options and Innovative Procedures for Stubborn Symptoms
While over-the-counter vaginal moisturizers and lubricants are foundational non-hormonal treatments, some women may find their symptoms persist or are severe enough to warrant more advanced therapies for vaginal atrophy. Fortunately, medical science continues to evolve, offering additional prescription options and innovative procedures that do not involve estrogen. These can be particularly beneficial for those who find OTC products insufficient or are looking for a deeper level of tissue restoration.
1. Vaginal DHEA (Dehydroepiandrosterone) Inserts (e.g., Intrarosa®)
- What it is: This is a prescription vaginal insert (ovule) containing prasterone, which is synthetic DHEA. DHEA is a naturally occurring steroid hormone that is converted into small amounts of both estrogen and androgen (male hormones) by the cells within the vagina after insertion.
- How it works: By providing DHEA locally, it directly stimulates the vaginal cells to increase their thickness, elasticity, and natural lubrication. Because the conversion happens primarily within the vaginal cells, systemic absorption is minimal. This makes it a compelling non-estrogen alternative for direct tissue revitalization.
- Pros: Highly effective in treating vaginal dryness, painful intercourse (dyspareunia), and associated urinary symptoms. Provides significant tissue restoration without external estrogen.
- Cons: Requires a prescription. May cause mild vaginal discharge or spotting initially. It’s a newer option compared to local estrogen, so long-term data is still accumulating, though current data is positive.
2. Oral Ospemifene (Selective Estrogen Receptor Modulator – SERM) (e.g., Osphena®)
- What it is: Ospemifene is a prescription oral medication (Selective Estrogen Receptor Modulator, or SERM) that acts like estrogen on vaginal tissues but has anti-estrogen effects in other parts of the body, like the breast and uterus.
- How it works: Taken daily as a pill, it helps to thicken the vaginal lining, reduce dryness, and alleviate painful intercourse.
- Pros: Systemic medication for women who prefer an oral option over vaginal inserts. Effective for moderate to severe GSM.
- Cons: Because it’s an oral medication, it has more systemic effects and potential side effects than topical vaginal therapies (e.g., hot flashes, muscle spasms, vaginal discharge). It also carries a boxed warning regarding endometrial cancer and blood clots, similar to systemic estrogen, although the risk is low. Requires careful discussion with a healthcare provider.
3. Vaginal Laser Therapy (e.g., MonaLisa Touch®, Juliet® Laser)
- What it is: A non-hormonal, non-ablative laser treatment performed in a doctor’s office. The laser delivers controlled energy to the vaginal tissue.
- How it works: The laser stimulates collagen production, improving the thickness, elasticity, and lubrication of the vaginal walls. It aims to restore the youthful characteristics of the tissue.
- Pros: Non-hormonal, quick, in-office procedure. Can be highly effective for addressing severe atrophy.
- Cons: Multiple sessions are usually required (typically 3 treatments, 4-6 weeks apart, followed by annual touch-ups). Can be expensive and is often not covered by insurance. Long-term data and efficacy compared to local estrogen are still being studied.
4. Platelet-Rich Plasma (PRP) Therapy (More Experimental)
- What it is: An experimental treatment where a woman’s own blood is drawn, processed to concentrate platelets (rich in growth factors), and then injected into the vaginal and clitoral tissues.
- How it works (proposed): The growth factors are thought to stimulate tissue regeneration, collagen production, and improve blood flow, potentially leading to improved sensation, lubrication, and tissue health.
- Pros: Uses the body’s own healing properties.
- Cons: Highly experimental, not FDA-approved for this use, and limited scientific evidence for efficacy. Can be very expensive and may require repeat treatments.
These advanced non-hormonal treatments and lifestyle strategies offer a multi-faceted approach to managing menopausal vaginal health for women who prefer to avoid hormones or need additional support. Always discuss these options thoroughly with your healthcare provider to determine the best path for your individual needs.
Complementary Strategies: Enhancing Non-Hormonal Relief
Lifestyle, Self-Care, and Holistic Approaches for Vaginal Wellness
Managing vaginal atrophy effectively without estrogen is a comprehensive endeavor. Beyond direct treatments like moisturizers, lubricants, or advanced therapies, incorporating thoughtful lifestyle adjustments and diligent self-care practices can significantly amplify your comfort and promote overall vaginal wellness. These complementary strategies work synergistically to support tissue health and reduce irritation.
1. Optimize Your Daily Hygiene:
- Gentle Cleansing: The vagina is a self-cleaning organ. Avoid harsh, fragranced soaps, bubble baths, douches, and scented feminine hygiene sprays. These products can strip natural oils, disrupt the delicate vaginal pH balance, and irritate already sensitive atrophied tissues. Use only plain warm water or a very mild, unfragranced, pH-balanced cleanser for external vulvar washing only.
- Soft Toilet Paper: Opt for soft, unbleached, and unscented toilet paper to minimize irritation during wiping.
- Pat Dry: Instead of rubbing, gently pat dry the vulvar area after bathing or using the toilet.
2. Choose Breathable Clothing and Underwear:
- Cotton Underwear is Key: Wear underwear made from 100% cotton. Cotton is breathable, allows for air circulation, and absorbs moisture, helping to prevent excess heat and dampness that can lead to irritation or infections. Avoid synthetic fabrics like nylon or satin for daily wear.
- Avoid Overly Tight Clothing: Limit prolonged wearing of very tight pants, leggings, or shapewear. These can increase friction, trap heat, and restrict air circulation around the vulva, exacerbating discomfort.
3. Maintain Regular Sexual Activity (Comfortably):
- Promotes Blood Flow: Consistent sexual activity (with or without a partner), ideally with comfortable lubrication, can help maintain blood flow and elasticity in the vaginal tissues. Increased circulation nourishes the tissues and can help preserve some level of elasticity and natural lubrication. “Use it or lose it” holds some truth for vaginal tissue health.
- Always Use Lubrication: Ensure consistent and liberal use of a high-quality personal lubricant during any intimate activity to prevent friction and micro-tears on atrophied tissues.
4. Hydration and Diet:
- Systemic Hydration: Drinking plenty of water throughout the day supports overall bodily hydration, which can indirectly contribute to the health and moisture of mucous membranes, including vaginal tissues.
- Balanced Diet: A nutritious diet rich in whole foods, healthy fats (like those found in avocados, nuts, and olive oil), and antioxidants supports overall health, hormonal balance, and tissue integrity throughout the body, contributing to better outcomes for vaginal health.
5. Consider Pelvic Floor Physical Therapy:
- Address Muscular Issues: If you experience pain during intimacy, a feeling of tightness, or other discomforts, it might involve the pelvic floor muscles. A specialized pelvic floor physical therapist can assess for muscle tension, weakness, spasms, or scar tissue. They can provide exercises, manual therapy, and techniques to relax and strengthen these muscles, improving comfort and sexual function.
6. Embrace Stress Management Techniques:
- Impact on Overall Health: Chronic stress can impact various bodily systems, including hormone regulation and pain perception. Incorporating stress-reducing practices into your daily routine, such as mindfulness, meditation, yoga, deep breathing exercises, or engaging in relaxing hobbies, can indirectly contribute to overall well-being and potentially alleviate discomfort.
By diligently integrating these complementary strategies, you can significantly enhance the effectiveness of non-hormonal treatments, providing a more comprehensive and holistic approach to managing vaginal atrophy and reclaiming your comfort and confidence throughout menopause.
When to Consult Your Doctor: Professional Guidance for Non-Hormonal Care
Knowing When to Seek Expert Advice for Vaginal Atrophy Symptoms
While many women successfully manage vaginal atrophy symptoms with over-the-counter non-hormonal products and lifestyle changes, it’s crucial to recognize when professional medical guidance is necessary. Vaginal atrophy is a medical condition, and a healthcare provider can offer an accurate diagnosis, rule out other conditions, and provide access to prescription non-hormonal therapies or discuss other treatment avenues that self-care alone cannot resolve.
You should consult your healthcare provider if:
- Symptoms Persist or Worsen Despite Self-Care: If your vaginal dryness, itching, burning, or irritation does not significantly improve after consistent use of quality over-the-counter vaginal moisturizers and lubricants (typically after 4-6 weeks of regular use), or if your symptoms continue to worsen. This indicates a need for a more targeted or potent intervention.
- Persistent Painful Intercourse: If intimacy remains consistently painful (dyspareunia) despite ample use of personal lubricants and regular use of vaginal moisturizers, a medical evaluation is essential. This could indicate more advanced tissue atrophy or other issues that require a prescription intervention.
- New or Unusual Symptoms: Any new or changing vaginal discharge (especially if accompanied by unusual odor or color), persistent unexplained vaginal bleeding or spotting (particularly if you are post-menopausal), or new or worsening pain in the pelvic area should prompt an immediate visit to your doctor. These symptoms could indicate an infection, a dermatological condition, or another more serious gynecological issue that needs prompt medical attention.
- Recurrent Urinary Tract Infections (UTIs): If you experience frequent or recurrent UTIs, especially in conjunction with vaginal dryness and irritation, it’s important to consult your doctor. The thinning of the urethra and bladder lining due to estrogen decline can make you more susceptible to infections. Your doctor can explore treatments to address this link.
- Considering Advanced Non-Hormonal Options: If you’re interested in exploring prescription non-hormonal therapies (such as vaginal DHEA inserts or oral ospemifene) or procedural therapies (like vaginal laser), these require a doctor’s evaluation and prescription or referral.
- Significant Impact on Quality of Life: If vaginal atrophy symptoms are significantly impacting your daily comfort, self-esteem, intimate relationships, or overall quality of life, please do not hesitate to seek professional help. Your doctor can offer effective solutions and support to improve your sexual health.
What Your Doctor Can Offer:
- Accurate Diagnosis: A physical examination and thorough discussion of your symptoms can confirm vaginal atrophy and rule out other conditions that might mimic its symptoms.
- Personalized Treatment Plan: Based on your specific symptoms, medical history (including any contraindications to hormonal therapies), and preferences, your doctor can recommend the most appropriate non-hormonal treatments (or discuss hormonal options if suitable and desired).
- Prescription Therapies: They can prescribe advanced non-hormonal options, such as vaginal DHEA inserts or oral ospemifene.
- Referrals to Specialists: Your doctor can provide referrals to specialized professionals, such as a pelvic floor physical therapist for muscular issues or a urogynecologist for complex urinary symptoms.
- Holistic Guidance: Provide tailored advice on lifestyle adjustments and self-care practices that complement medical treatments.
- Ongoing Monitoring: Monitor your progress, manage any potential side effects, and adjust your treatment plan as needed to ensure long-term comfort and optimal vaginal health.
Remember, managing menopausal vaginal atrophy is a journey, and your healthcare provider is your essential partner. Don’t hesitate to reach out for professional guidance to ensure you receive the most effective and safe relief.
Patient Perspectives: Finding Comfort Without Hormones
Real Stories of Relief and Empowerment in Menopause
For far too long, women facing the uncomfortable realities of menopausal vaginal atrophy often felt their options were limited, or worse, that they simply had to endure the discomfort as an inevitable part of aging. This quiet suffering stems from a lack of awareness about effective treatments and a reluctance to discuss such intimate concerns. However, on this vaginal health blog, we’re committed to breaking that silence by sharing powerful, authentic stories. These testimonials highlight the transformative impact of diverse non-hormonal treatments, empowering women to seek the comfort, confidence, and quality of life they truly deserve.
Consider Sarah, 52, who experienced significant vaginal dryness and painful intercourse during perimenopause but was hesitant about hormonal treatments due to a personal preference for non-hormonal approaches. “I felt like I was stuck between a rock and a hard place,” she recalled. “Intimacy became something I dreaded, and even just walking made me feel chafed.” Her gynecologist recommended a consistent routine with a high-quality hyaluronic acid vaginal moisturizer and a silicone-based lubricant for intimacy. Sarah committed to the regimen, using the moisturizer every three days and the lubricant as needed. “It wasn’t an overnight miracle, but after about a month, the difference was profound,” she shared with a radiant smile. “My daily discomfort disappeared, and intimacy is not just bearable but truly pleasurable again. I I’m so grateful there were effective non-hormonal choices for me, and I didn’t have to compromise my preferences.”
Or take Emily, 59, a breast cancer survivor who developed severe vaginal atrophy post-treatment, making hormonal options largely unavailable to her. “The dryness and burning were debilitating; I could barely sit comfortably, and sex was completely out of the question,” Emily explained. “I was also getting recurrent UTIs, which made everything worse. My quality of life had plummeted.” Her oncology and gynecology teams collaborated, and Emily decided to try vaginal DHEA inserts (Intrarosa®). “It’s been life-changing,” Emily reported enthusiastically. “The tissue health has improved dramatically, the dryness is gone, and the constant threat of UTIs has stopped. It’s truly incredible to have found this level of relief and confidence without using estrogen.”
And then there’s Maria, 64, who, after trying over-the-counter moisturizers for a while, found she still needed more significant improvement for her persistent tightness and painful intimacy. “The moisturizers helped, but I still felt a persistent lack of elasticity that impacted my comfort, especially during sex,” Maria said. “My doctor suggested vaginal laser therapy. It was a commitment of a few in-office sessions, and it was an out-of-pocket cost, but for me, it was absolutely worth every penny. My vaginal tissues feel much healthier and more elastic, almost like they did years ago. The long-term comfort and vastly improved intimate experiences are fantastic. I feel so much more connected to myself and my partner.”
These powerful, real-life testimonials highlight several crucial aspects of non-hormonal treatments for menopausal vaginal atrophy:
- Effective and Lasting Relief: Non-hormonal options, ranging from accessible topical moisturizers and lubricants to prescription DHEA inserts and advanced laser therapies, provide substantial and enduring relief from vaginal dryness, itching, burning, and painful intercourse.
- Diverse Options for Every Need: The wide spectrum of non-hormonal choices means that women can find solutions tailored precisely to their symptoms, medical history, and personal preferences, ensuring that no one has to suffer in silence or feel limited in their choices.
- Empowerment Through Choice: These treatments offer vital and proven alternatives for women who cannot or prefer not to use hormonal therapies, affirming their autonomy and control in managing their health during menopause.
- Profound Improvement in Quality of Life: By effectively addressing these bothersome and often debilitating symptoms, non-hormonal treatments enable women to regain comfort in daily activities, enjoy a fulfilling intimate life, and enhance their overall well-being and confidence during and after menopause.
These inspiring narratives serve as a powerful reminder that menopausal vaginal atrophy is a treatable condition, and diverse, effective non-hormonal pathways to comfort and vitality are readily available to help every woman thrive and live her best life.
Medical Disclaimer
The information provided in this article is for general informational purposes only and does not constitute medical advice. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article. Reliance on any information provided by this blog is solely at your own risk. Product and treatment recommendations are general, and individual results and suitability may vary.
Resources:
- The North American Menopause Society (NAMS): Menopause.org
- American College of Obstetricians and Gynecologists (ACOG): ACOG.org
- Mayo Clinic: Mayoclinic.org – Vaginal Atrophy
- PubMed Central: National Institutes of Health (NIH) research articles on genitourinary syndrome of menopause and related treatments.