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Menopause
You’ve likely heard of menopause being a difficult or troublesome time because of the symptoms that many women experience as they approach it. If you get unwanted symptoms as your period becomes less regular and reliable, our practice can offer evaluation and initiationof hormone therapy to regulate your hormones and improve your quality of life during your menopausal transition.
To learn more about menopause treatment, call our practice, or book an appointment online today.
Menopause is the period of your life that marks the end of your menstrual cycles. It usually happens sometime in your late 40s or early 50s, but can happen earlier if you have a hysterectomy or a condition called primary ovarian insufficiency.
You stop getting periods and many of the symptoms and complications that come from them, and you can no longer get pregnant. You know you’ve officially entered menopause when you have gone 12 full months without a period.
Leading up to menopause is a stage called perimenopause. When people talk about menopause symptoms, they’re usually talking about the symptoms that come with perimenopause.
During this time, your hormones are constantly fluctuating while on a general decline. This can cause many unforeseen symptoms and complications that might cause you to seek treatment.
Dr Hall can help you regulate your hormones to alleviate symptoms during perimenopause and menopause. Instead of letting these symptoms disrupt your life, you may be able to undergo hormone therapy.
If you’re entering menopause and have symptoms that interfere with your work, relationships, or sleep, call our practice, or book a consultation for hormone therapy online today.
Dr Hall can help you regulate your hormones to alleviate symptoms during perimenopause and menopause. Instead of letting these symptoms disrupt your life, you may be able to undergo hormone therapy.
If you’re entering menopause and have symptoms that interfere with your work, relationships, or sleep, call our practice, or book a consultation for hormone therapy online today.
The genitourinary syndrome of menopause (vaginal atrophy or atrophic vaginitis) frequently affects perimenopausal and postmenopausal women. It’s a condition where the lining of the vagina gets drier and thinner from a lack of estrogen. Burning, itching, spotting and pain with sex are common symptoms, as are frequent urination and urinary tract infections.
Vaginal refers to the vagina while atrophy means “a wasting away or diminution.” Recently, the term vaginal atrophy has been replaced with the newer term, Genitourinary Syndrome of Menopause (GSM). This new term helps describe not just the vaginal, but also the urinary symptoms that can be accompanied by the effects of low oestrogen.
Vaginal atrophy most often occurs during menopause, the “change of life.” This happens because of a decrease in the hormone oestrogen. It can occur in younger women, as well, when their oestrogen levels are affected.
Women age 50 and over, in menopause, are the most likely to experience vaginal atrophy. Other factors that increase your likelihood of developing vaginal atrophy include:
– Lack of sexual intercourse.
– Decreased ovarian functioning due to chemotherapy or radiation.
– Immune disorders.
– Medications that contain antioestrogen properties including Tamoxifen (Nolvadex), Medroxyprogesterone (Provera) and Nafarelin (Synarel).
– Nonfluctuating oestrogen levels.
– Oophorectomy (removal of the ovaries).
– Postpartum loss of placental oestrogen.
– Smoking.
– Breastfeeding.
Symptoms of vaginal atrophy can include:
– Dryness of the vagina.
– Burning and/or itching of the vagina.
– Dyspareunia (pain during sex).
– A discharge from the vagina – usually a yellow color.
– Spotting or bleeding.
– Vulvar itching (pruritus).
– Feeling of pressure.
It can also affect your urinary system and cause symptoms. These include:
– Frequency of urination (going to the bathroom often).
– Dysuria (having pain or a burning sensation when going to the bathroom).
– Urinary tract infections (UTIs).
– Urinating more.
– Stress incontinence.
– Blood in the urine (hematuria).
Your healthcare provider can diagnose vaginal atrophy based on your symptoms and a pelvic exam to look at how the vagina appears. It will help to know whether or not you are in menopause.
Classic signs of atrophy during a pelvic exam include:
– A shortened or narrowed vagina.
– Dryness, redness and swelling.
– Loss of stretch in the skin.
– Whitish discoloration to the vagina.
– Sparsity of pubic hair.
– A bulge in the back wall of the vagina.
– Vulvar skin conditions (dermatoses), vulvar lesions and/or vulvar patch redness (erythema).
– A bladder that has sagged into the vagina.
– Urethral lesions.
– Minor cuts (lacerations) near the vaginal opening.
The vast majority of the time, a trained clinician can easily diagnose atrophic and GSM changes with a careful physical exam. Occasionally laboratory tests are required to differentiate vaginal atrophy from other conditions such as:
– Pap test.
– Urine sample.
– Ultrasound.
– Serum hormone testing.
– Vaginal pH.
– Microscopy.
You and your healthcare provider will work closely together to come up with a treatment plan for vaginal atrophy. They’ll help you decide which plan is most effective based on your symptoms and the severity of them. Oestrogen therapy is considered to be the most effective.
Some treatments are meant to treat the symptoms of atrophy. Others address the loss of oestrogen, specifically, which will also act to relieve symptoms.
Lubricants and moisturizers to add moisture and to loosen the vagina can treat dryness. This improves comfort during sex. The moisturizers won’t completely restore the health of the vagina. Multiple brand names are available over-the-counter. Some are vaginal moisturizers for irritation and dryness throughout the day, similar to a skin moisturizer (Replens, Hyalofemme, Silk-E, and others). Others are personal lubricants best used during sexual activity (Astroglide, Uber Lube, Condom-Mate suppository, Today brand personal lubricant, K-Y liquid formula). Vaseline is NOT recommended for use inside the vagina because it can lead to yeast infections. Though many women use olive or coconut oils as a moisturizer and lubricant, occasionally this may cause an allergic irritation in the vaginal area. Vitamin E and mineral oils should be avoided.
Dilators are devices to widen (dilate) the vagina to enable you to go back to having sex. Women often start with a narrow dilator and move on to larger sizes over time. This is done until the vagina is wide enough to fit a penis for sexual activity without pain. The best results are obtained when dilators are used in conjunction with local hormone therapy.
Sexual activity should not be avoided if you have vaginal atrophy. A lack of sexual activity actually worsens the condition. Sex stimulates blood flow in the vagina and aids in the production of fluids so, therefore, sex actually keeps the vagina healthy.
Hormone therapy not only improves symptoms of vaginal atrophy the best, but also brings back the health of the skin by restoring the normal acid balance of the vagina, thickening the skin (back to how it was originally), maintaining natural moisture and improving bacterial balance. Douching should be avoided.
Luckily, for women who are only having vaginal atrophy
symptoms, there are several options that allow oestrogen to be delivered only to the vagina. These options can help to avoid high hormone levels in the rest of the body. Women who are having multiple other menopausal symptoms — such as hot flashes and difficulty sleeping — may choose to use hormone therapy at higher doses to treat all of their symptoms (referred to as systemic hormone therapy). The local vaginal hormone options will not treat any menopausal symptoms besides the vaginal ones.
Vaginal low-dose oestrogen therapy (local therapy). These
formulations are meant to treat only vaginal symptoms, as they are not being absorbed by the rest of the body. They are available in the forms of a cream (two types, estradiol or conjugated oestrogens), a vaginal pill/suppository, or a ring which is left in the vagina for three months. After three months, the old ring is removed and a new one is inserted. Many women confuse vaginal oestrogen only forms of treatment with systemic hormone therapy, and unnecessarily worry about risks of blood clots, heart disease, etc.
Systemic hormone therapy (also called hormone replacement therapy). This is taken in higher doses that go to other cells of the body, not just to the vagina. If you are more than 10 years past menopause, or only have vaginal symptoms, you will more likely be using local therapy. However many women on systemic hormone therapy benefit from improved bone health, vaginal health, better sleep, less hot flashes and improved mood, among other health benefits. You should discuss with your doctor whether systemic hormone therapy is right for you.
Are there complications/side effects of treatment?
Pay attention to any new symptoms that come after you start treatment. These could be irritation to the skin, more pain and/or discharge. Discuss any possible side effects with your healthcare provider. Don’t hesitate to consult your healthcare provider if you’re uncomfortable!
Can vaginal atrophy (atrophic vaginitis) be prevented?
A woman’s body naturally secretes less oestrogen with age. This cannot be prevented. Without intervention, it’s unlikely that the ovaries will make more of the hormone.
However, there are ways to keep vaginal atrophy from getting worse. Avoid tight-fitting clothing, panty liners, perineal pads and any of the following that you may find irritating to your vagina:
– Perfumes.
– Powders.
– Deodorants.
– Spermicides
– Lubricants.
What can I expect if I’ve been diagnosed with vaginal atrophy (GSM)?
You don’t have to just “live with” vaginal atrophy. Even if you’re in menopause or postmenopausal, that doesn’t mean you should have to deal with UTIs, endure itching or burning, or painful sex. Treatment not only helps with symptoms, but it helps restore a healthy pH and bacterial balance back to your vagina.
Can vaginal atrophy (atrophic vaginitis, GSM) be cured?
You don’t have to live with the discomfort of vaginal atrophy. With proper diagnosis and treatment, the symptoms can be managed.
Can vaginal atrophy (atrophic vaginitis) get worse?
Be sure to address your symptoms quickly with your healthcare provider. The sooner you get treatment, the less likely it is that your vaginal atrophy will worsen. For example, the longer you go without oestrogen, the dryer the vagina will become. Without treatment, yes, your vaginal atrophy may get worse. Occasionally, atrophy can become so severe that it can significantly narrow the vaginal opening. This may make it harder to treat the atrophy if treatment is initiated too late.
What is it like living with vaginal atrophy (atrophic vaginitis)?
Vaginal atrophy can seriously affect your quality of not just your sex life, but life in general. The pain, dryness, burning/itching, spotting, bleeding, urinary problems, UTIs and discharge can make you very uncomfortable and interfere with your daily living. One in four women report that vaginal atrophy has had a negative impact on other areas of their lives including their sleep, sexual health and general happiness.
How do I take care of myself?
Prioritize your sexual health as much as any other aspect of your health. Look to your healthcare provider for answers to any questions and concerns. Take your over-the-counter medications and prescriptions exactly as directed.