In a previous blog post – Sexual Changes during Perimenopause and Beyond – I reviewed some of the sexual changes that may occur with menopause. One of the most common sexual issue for postmenopausal women is vaginal atrophy (atrophic vaginitis), the thinning and inflammation of vaginal walls induced by declining estrogen. Vaginal atrophy can lead to vaginal dryness and painful sexual intercourse.
Although many women do not seek help for this condition, estrogen treatment has been proven effective in restoring vaginal health and improving symptoms.
Estrogen Options
There are a number of low dose hormone therapies available in a variety of forms such as vaginal tablets, rings and creams. These local therapies relieve dryness and painful intercourse by rebuilding the lining of the vagina and urethra. Compared with oral formulations, locally administered estrogen therapies have lower risks because they do not act systemically with minimal absorption throughout the body. Another option is now available with the recent FDA approval of a lower dose (10mcg) formulation of Vagifem (estradiol vaginal tablets, from Novo Nordisk) for the treatment of atrophic vaginitis due to menopause. Vagifem is already available as a 25mcg vaginal tablet but the new dose formulation makes it the lowest local estrogen dose available in the U.S., giving women another option for consideration.
Get Primed! Tip: If you are having sexual function issues, be proactive and discuss with your healthcare provider to identify possible treatment options.
Many biological changes occur during perimenopause and continue after menopause, including changes in sexual function. Unfortunately, sexual function and its impact on women’s quality of life is infrequently discussed and rarely addressed during visits with healthcare providers. Women may experience decreased vaginal lubrication, decline in libido (sexual drive) and dyspareunia (painful intercourse). Estrogen levels, which decline with menopause, impact vaginal function, blood flow and secretions. The result can be painful intercourse and a decrease in sexual desire. In some cases, diminishing estrogen can lead to bleeding and formation of adhesions. Taken together, these biological changes can create a range of sexual challenges for women as they age.
As a first step, non-hormonal vaginal lubricants/moisturizes may help. However, these products are not always effective. Next, one might consider locally administered hormone therapy to alleviate the vaginal effects of declining estrogen levels. There are many new effective low dose hormones therapies available in a variety of forms such as vaginal tablets, rings and creams. These local therapies relieve vaginal dryness and painful intercourse by rebuilding the lining of the vagina and urethra. Compared with oral formulations, locally administered estrogen therapies have lower risks because they do not act systemically. Since there are a number of treatment options, it is certainly worth discussing the impact of peri and post-menopause on your sex life with your healthcare provider.
Get Primed! Tip: If you are having sexual function issues, be proactive and discuss with your healthcare provider to identify possible treatment options.
