Many of the aches and pains of getting older can be taken in our stride – not being able to do cartwheels on the beach anymore may not seem to be a great sacrifice, but some aspects of aging simply don’t seem fair. Among other effects, declining estrogen levels cause thinning and inflammation of the vaginal walls, termed vaginal atrophy. Less circulating estrogen causes vaginal tissues to become drier, more fragile and less elastic.
A drop in estrogen can occur during the years leading up to menopause; during breastfeeding; after surgical removal of both ovaries, hysterectomy or after natural menopause; after pelvic radiation therapy or chemotherapy for cancer; and as a side effect of hormonal treatment for breast cancer, which, in turn, can lead to vaginal atrophy.
The symptoms include vaginal itching and dryness and this can make intercourse painful1. Additionally, a burning sensation or urgency when urinating, incontinence and slight bleeding after intercourse can occur2. And if you become a regular sufferer of urinary infections, it’s wise to investigate your hormone levels and the possibility of vaginal atrophy.
Any discomfort during intercourse should be discussed with your health care practitioner, especially if it isn’t resolved with vaginal moisturisers.
The most common and effective treatment is estriol, in tablet, cream or vaginal ring form3. Another treatment found to be helpful is the use of low-dose DHEA. The precursor to other sex hormones, DHEA declines with age and by the time a woman reaches menopause (usually, in her early 50s), production of this hormone is already down by around 60%4. Because regular sexual activity has been found to assist in keeping vaginal tissues healthy, the use of DHEA in menopause seems to be beneficial and may subsequently assist in reducing the risk of vaginal atrophy5,6. Additionally, progesterone administered in vaginal tablet or cream has also been shown to be effective7.
DON’T BE SHY
Even though this is a common condition, women still seem reluctant to seek treatment, either because of embarrassment or because they don’t know there are treatment options. There’s no reason for you to suffer from these symptoms, so if you’re experiencing vaginal dryness that causes pain during intercourse, or an increased number of urinary infections, speak to your doctor.
1 Suckling J, Kennedy R, et al. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Menstrual Disorders and Subfertility Group. Pub online Jan 2009 onlinelibrary.wiley.com/doi/10.1002/14651858.CD001500. pub2/abstract
2 The Mayo Clinic. Vaginal Atrophy. www.mayoclinic.com/health/vaginal-atrophy/DS00770 Jan 2012
3 Simon J, Nachtigall L, et al. Effective Treatment of Vaginal Atrophy With an Ultra– Low-Dose Estradiol Vaginal Tablet. Obstetrics & Gynecology. Nov 2008;112(5):1053-60
4 Traish A, Kang P, et al. Dehydroepiandrosterone (DHEA) – A Precursor Steroid or an Active Hormone in Human Physiology (CME). The Journal of Sexual Medicine. Nov 2011;8(11):2960-82
5 Kelley C. Estrogen and Its Effect on Vaginal Atrophy in Post-Menopausal Women. Society of Urologic Nurses and Associates. 2007;27(1):40-5
6 See reference 2
7 Noe G, Sitru-Ware R, et al. Endometrial effect of progesterone delivered by vaginal rings in estrogen-treated postmenopausal women. Climacteric. Oct 2010;13(5):433-41