Women of a certain age can feel dry as the desert “down there.” About half of women past menopause report bothersome vaginal symptoms such as extreme dryness, researchers find. Remedies abound—drugstore shelves are full of ”vaginal moisturizers,” and your doctor can prescribe low-dose estrogen creams and tablets, a pricier (and in some cases messier) remedy.

So, what works to undo the dryness? In a new study, a team of researchers compared a variety of treatments, ranging from over-the-counter remedies to prescription ones.

The good news? Everything helped, even the placebo treatments. (The placebo treatments used had some of the same ingredients as vaginal moisturizers do.)  Just pick the stuff that works for you, says Caroline Mitchell MD, MPH, assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School. The results of her study, published in JAMA Internal Medicine, can help guide you. She also directs the vulvovaginal disorders program at Massachusetts General Hospital.

Estradiol vs. Moisturizer vs. Placebo

In the study, the researchers randomly assigned 302 women, average age 61, to use one of three treatment regimens:

• Vaginal 10-microgram estradiol tablet plus placebo gel

• Placebo vaginal tablet plus vaginal moisturizer

• Dual placebo

At the study start, women reported their most bothersome symptom—for most it was pain with vaginal penetration, Mitchell says, followed by dryness. They scored their symptoms—and all three groups were about the same in severity—ranging from moderate to severe.

The women used the vaginal tablet daily for two weeks, then twice weekly, and used the gel three times a week. After 12 weeks, all group had similar reductions in their symptoms, rating them about 1.5 points less than at the start. No significant differences were seen between the estradiol and the moisturizer compared with placebo in terms of symptom relief or improving sexual function.

“The placebo gel had hyroxyethycellulose,” Mitchell says, and ”it’s common in many vaginal products. I think the good news is, everybody got a little better,” she says, ”and trying something is likely to be helpful.” One key point: “The majority of our participants did use these as prescribed,” she says. In other words, none of them work if they are parked in your nightstand.

More good news

The other good news? The cheaper options worked as well as the pricier ones.  In the study, the vaginal estradiol tablet Mitchell’s team looked at was prescription Vagifem. It sells for about $180 for 8 tablets, and the generic version is about $70 for 8 tablets. The researchers looked at the over-the-counter moisturizer Replens, which is about $12 for 8 applications.

Many women’s insurance plans do not cover the prescription estradiol, Mitchell finds. Also, women want to avoid hormone-based treatments, fearing cancer risk, although the low-dose estradiol tablets are viewed as low-risk, the experts say.

More Moisturizing 101

It’s great that all the options studied help, but how best to pick? “There’s no one thing right for everyone,” Mitchell says. It comes down to preference. In one study, she says, women preferred silicone-based moisturizers, which are more slippery than water-based ones. Some worry that silicone-based moisturizers boost the risk of getting a urinary tract infection, but Mitchell says “I think it’s sex more than anything that encourages UTIs.”

What about lubes?

Even if you moisturize faithfully, you may also want to use a vaginal lubricant prior to having sex to make intercourse more comfortable. While moisturizers can be used as a regular routine to keep tissues less dry, the lube can also help minimize pain during intercourse.

You can use commercial, over-the-counter lube products, or just grab some coconut oil or olive oil, Mitchell says. But oils can break down condoms, so beware. Reading the label on product is key, as some silicone lubricants claim to be compatible with certain condoms, such as natural rubber latex ones.

In general for lubes, she says, ”the fewer ingredients the better, as there is less to react to.” Most important, whatever remedy you choose: “If it causes irritation, stop using it,” Mitchell says.

For a graphic look at what’s happening with that vaginal tissue (but probably not right before a romantic evening), see this primer from the North American Menopause Society.