Midi offers many effective treatment options for vaginal dryness and painful sex. Our clinicians take your symptoms and health history into account when determining which is best for you. Treatments include:

- OTC products: Moisturizers, gels, and soothing agents address dryness by adding moisture around and inside the vagina. If used consistently, they can improve symptoms and make sex more comfortable. 
- Vaginal estrogen Available as a cream, ring, and suppository, vaginal estrogen treats the vaginal tissue where it’s applied.
- Hormone replacement therapy (HRT) HRT delivers estrogen through pills, patches, and other formulations and circulates throughout your body to address multiple menopause symptoms, including vaginal dryness. 

Midi offers many effective treatment options for low libido, and clinicians take your symptoms and health history into account when determining which is best for you. Treatments include:
- Counseling If relationship issues are affecting libido, counseling or sex therapy may help improve communication between you and your partner.
- Non-hormonal medications These include flibanserin (Addyi), bremelanotide (Vyleesi), and sildenafil citrate (Viagra).
- Hormone replacement therapy (HRT) HRT delivers estrogen through pills, patches, and other formulations and circulates throughout your body to address multiple menopause symptoms that may effect libido, including vaginal dryness and pain with sex.
- Testosterone treatment If a low libido is distressing or interfering with a patient’s quality of life, then testosterone may be recommended.
- Mental health medications Low doses of antidepressant bupropion (Wellbutrin) may help improve sexual desire. 
- Supplements Maca may have several benefits for treating menopause symptoms, including supporting libido.

Vaginal estrogen and hormone replacement therapy (HRT) are the two hormonal treatments used to treat vaginal symptoms of menopause, such as painful sex, dryness, frequent urination, and discomfort while urinating.

Available as a cream, ring, or suppository, vaginal estrogen is localized, meaning that it delivers estrogen directly to the vaginal tissue, helping to improve blood flow and lubrication. Vaginal estrogen stays where you put it without getting absorbed into your bloodstream. That’s why we can recommend certain types for almost all women, even those with a family or personal history of breast cancer.

Hormone replacement therapy is systemic, meaning that the estrogen circulates throughout your body. Delivered through pills, patches, and other formulations, HRT alleviates vaginal dryness in about 75 percent of cases, making it less effective than vaginal estrogen.That’s why Midi clinicians sometimes recommend vaginal estrogen instead of or alongside HRT.

Midlife care is uniquely suited to telehealth, because what women require at this stage, more than anything, is in-depth conversation with a clinician who has the time to listen to her experience and explore personalized solutions. In-person exams reveal very little that you can’t tell us yourself. In fact, after age 45, the only routine in-person Ob/Gyn care you need is a Pap smear, and for most women, it’s recommended every five years, not annually. We order any labs or screening needed to inform and guide your treatment. While we encourage you to keep up your relationships with your regular doctors (and we will refer you to one if necessary), we think our virtual care is the key to strong support at midlife. Here’s why:

- Expertise: Specialists in perimenopause, menopause, and other areas of women’s midlife health are in short supply. Most have long waiting lists. Midi gives you access to expert guidance immediately.
- Convenience: Telehealth allows you to connect with a Midi clinician from anywhere, with no travel time or sitting in a waiting room. Our care coordinators send you to local labs and imaging centers to make the testing you need easy.
- Comfort: Virtual visits from your own private space help you to feel relaxed so you can better connect with your clinician.
- Communication: Our digital platform supports messaging that lets you reach us anytime, and get a prompt response.
- Frequent check-ins: The ease of virtual visits allows us to stay in touch with you, scheduling check-ins throughout the year instead of annually, to track your progress and get ahead of any new symptoms. That approach helps you stay healthy and well through this chapter of change.

Our clinicians are licensed nurse practitioners (NPs), CNMs (nurse midwives), doctors (MDs), and naturopathic doctors (NDs) who specialize in women’s midlife health. In addition to their invaluable clinical experience, they receive intensive training from nationally-recognized experts in perimenopause and menopause. All Midi treatment is overseen by menopause doctors who work closely with clinicians to create a Care Plan personalized to every patient.