Patient description: The patient is a 47-year-old Asian woman complaining of persistent feelings of sadness. She lost interest in activities she used to enjoy. She states that her mood is mostly depressed for the past 3 weeks. She also lost her appetite , which led to about 5kg weight loss. She complains of loss of energy and feelings of worthlessness nearly every day. She is not using any drugs and she does not smoke. She doesn't drink alcohol. She used to exercise every day for at least 30 min. But she doesn't have enough energy to do so for the past 3 weeks. She also has some digestive issues recently. She is married and has 4 children. She is menopausal. Her husband was recently diagnosed with colon cancer and he is starting his chemotherapy. There is nothing remarkable in her past medical history and her drug history is only positive for Vit D3 1000 units daily. Her family history is negative for any psychologic problems. Her HAM-D score is 20.

Clinical trial eligibility criteria: eligible ages (years): 21.0-80.0,  Vulvovaginal Atrophy Dyspareunia Subject provides written informed consent and HIPAA authorization before any study procedures are conducted 2. Subject is female 3. Subject is aged 21-80 years 4. Subject has a body mass index (BMI) < 37 kg/m2 5. Subject is menopausal either naturally (at least 12 months amenorrheic) or 6 weeks after a bilateral salpingo-oophorectomy prior to natural menopause subjects with hysterectomy only must have a serum Follicle Stimulating Hormone > 40 milli-International unit /mL 6. Subject has vulvovaginal atrophy with dyspareunia 7. Subject has had a normal mammogram within the last 6 months 8. Subject has normal pap smear within last 6 months 9. Subject has an endometrial stripe ≤ 4 mm within the last 6 months if she has a uterus 10. Subject agrees to comply with the study procedures and visits  Subject has a hypersensitivity to any of the ingredients of ospemifene 2. Subject has used ospemifene in the past 3. Subject has documented or suspected breast cancer, history of heart attack or stroke 4. Subject has clinically significant findings on physical examination 5. Subject has uncontrolled hypertension 6. Subject has any chronic medical condition or psychologic disorder that the Principal Investigator feels makes her ineligible for the study 7. Subject is currently on local or systemic androgen therapy including local or systemic testosterone (washout 14 days for local or topical androgen or non-depot injection, 1 month for depot, 6 months for pellet 8. Subject is currently on local or systemic estrogen therapy or androgen therapy (washout 14 days for vaginal estrogen, 60 days for oral/transdermal therapy) 9. Subject is currently using a Selective Estrogen Receptor Modulator (SERM) or products that have estrogenic or anti-estrogenic effects within last month 10. Subject currently using itraconazole, ketoconazole, digitalis or alkaloids heparin or strong cytochrome P 450 3A4 inhibitors 11. Subject has a history of substance abuse within 12 months prior, or consuming > 14 alcoholic drinks per week 12. Subject has received an investigational drug within 30 days prior to signing consent 13. Subject has any condition or exhibits behavior that indicates to the Principal Investigator that the Subject is unlikely to be compliant with study procedures and visits