Q & A Library

Premarin vaginal cream is a prescription product designed for women whose estrogen levels are low, as they are after menopause. I'm assuming that your bladder irritation and infections stem from post-menopausal vaginal dryness, a common cause of these problems. You could try cutting back on the dosage if you're concerned about reliance on the drug, but there are alternatives you can explore.

My colleague Ann L. Mattson, MD, medical director of the Boulder Valley Women's Health Center in Colorado and an associate fellow at the Program in Integrative Medicine here at the University of Arizona, suggests the prescription alternatives Estrace or Estrace vaginal cream that are "bioidentical" to the body's own estrogen but are made from plant sources (soy and wild yam). By contrast, the estrogen in Premarin comes from the urine of pregnant horses and is different chemically from the body's own hormones.

Dr. Mattson also suggests the following non-prescription options which she says have been shown to be helpful in reducing the vaginal dryness that occurs with menopause and should indirectly improve bladder symptoms associated with intercourse:

• Black Cohosh: This botanical remedy seems to reproduce some of the effects of estrogen, but does not have estrogenic activity. Try taking 5-30 drops of the standardized extract (orally) two to three times per day. Allow six to eight weeks to see an effect.

• Soy: Increase your intake of whole soy foods to two to three servings a day in order to get 50 to 150 mg of isoflavones daily. Here, too, allow several weeks to see the maximum benefit.

• Vitamin E: Apply 400-800 IU per day of oil from a capsule of Vitamin E directly to vaginal tissues at bedtime. You'll have to break the capsule to get the oil. Caution: some people develop irritation as a reaction to this type of Vitamin E use.

You can also minimize the chances of developing bladder problems by emptying your bladder before and after intercourse. To reduce the risk of recurrent bladder infections, increase your water intake and drink three ounces of cranberry juice per day or take one 500mg tablet of cranberry juice supplement daily.

Andrew Weil, M.D.