I’m a GYN specializing in menopausal medicine. I’ve been helping women manage their menopausal symptoms for the past 25 years, so all this talk about vaginal atrophy has left me feeling like I need to weigh in.
If we’re lucky to live long enough, all women will eventually go through menopause, that line in the sand when our Menses cease, marking the end of our fertile years. During this period of our lives, our ovaries no longer produce any appreciable amount of estrogen. For some women, this causes intolerable symptoms — such as hot flashes, night sweats, and insomnia — and for others, the symptoms are mild.
Most women will also eventually develop some symptoms of vaginal atrophy, referred to medically as the “genitourinary syndrome” of menopause. The vast majority will only experience minor changes, like decreased lubrication with intercourse, but for some women the symptoms will be more severe and might include things like decreased arousal with stimulation, difficulty reaching orgasm, chronic itching burning and discomfort of the vulva, and more urinary tract and vaginal infections. Others might experience pain with intercourse, possibly accompanied by tearing and bleeding from a narrowed or scarred vagina.
That’s the bad news. The good news is that most of these symptoms are easily addressed with safe and effective treatments.
For minor symptoms of atrophy, simply using a vaginal lubricant like K-Y Liquid, Astroglide, or even coconut oil will solve the problem. Some may find that using an over-the-counter vaginal suppository every three days (like Replens) is sufficient.
When these common drug store solutions don’t quite cut it, you can see your doctor and ask for vaginal estrogen. There are different FDA-approved estrogen products available by prescription for the treatment of genitourinary urinary syndrome of menopause. Vaginal creams, vaginal tablets, and a ring that is left inside the vagina for three months at a time are all extremely effective. Unlike the use of systemic estrogen (pills or patches), the risk associated with the use of vaginal estrogen is minimal. Multiple scientific studies have clearly documented that there is, at most, minuscule systemic absorption of these vaginal estrogen products into the bloodstream. Because of that, they can be used long term with minimal to no risk.
Women with a history of hormone sensitive breast cancer are generally advised against the use of even small doses of vaginal estrogen. Until recently, there was very little available to help these women. However, a new, in-office vaginal laser therapy (“Mona Lisa Touch” or “THERMIva”) appears to be effective and safe in early clinical trials. Unfortunately, these treatments are still considered experimental, not generally covered by health insurance, and quite costly. Nevertheless, this appears to be an excellent option for women who have an absolute contraindication to using estrogen, or those women who prefer not to use medication.
The most important thing is to not suffer in silence. Find a doctor with whom you can speak comfortably about these issues because they are treatable, and you deserve optimal vaginal health!