Hormone Therapy and Vaginal Dryness ⋆ Meno Martha International...

“Local low-dose estrogen therapy is preferred for women whose symptoms are limited to vaginal dryness or associated discomfort with intercourse or for…”.¹

Umbrella
What may the Hormone Therapy and Vaginal Dryness Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

Atrophic Vaginitis
Genital Atrophy
Genitourinary Syndrome of Menopause
Hormone Replacement Therapy (HRT)
Hormone Therapy (HT)
Local Low-Dose Estrogen Therapy
Menopausal Hormone Therapy (MHT)
Vaginal Atrophy
Vaginal Dryness
Vaginal Estrogen/Oestrogen
Vaginal Symptoms
Vulvovaginal Atrophy

Vaginal Dryness

What is vaginal dryness?

DotS the definition of vaginal dryness may vary. In Vaginal Dryness After Menopause: How To Treat It? I’m postmenopausal and often have vaginal dryness, which makes intercourse painful. Is there anything I can do about it? the (United States) Mayo Clinic’s definition is:

“Vaginal dryness can be a problem for many postmenopausal women. Vaginal dryness is a hallmark sign of the genitourinary syndrome of menopause, also known as atrophic vaginitis or vaginal atrophy. With this condition, vaginal tissues become thinner and more easily irritated — resulting from the natural decline in your body’s estrogen levels during menopause”.²

Statements

What is one of the points of consensus about menopausal hormone therapy (MHT) and vaginal dryness?

One of the points of consensus in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT – endorsed by seven menopause-related organizations – published online 20 June 2016, is:

“MHT, including tibolone, is effective in the treatment of vulvovaginal atrophy (VVA), now also considered as a component of the genitourinary syndrome of menopause (GSM). Local low-dose estrogen therapy is preferred for women whose symptoms are limited to vaginal dryness or associated discomfort with intercourse or for the prevention of recurrent urinary tract infections”.³

NICE Guidelines

What do the (British) National Institute for Health and Care Excellence’s (NICE) guidelines note about HT and vaginal dryness?

In Menopause: Diagnosis and Management – Information for the Public: Managing Your Symptoms the NICE note about Vaginal Dryness:

“If you have vaginal dryness you should be offered vaginal oestrogen, which is put directly into the vagina as a pessary, cream or a vaginal ring. You can use vaginal oestrogen for as long as you need to, even if you are already using HRT. Moisturisers and lubricants can also help. If vaginal oestrogen doesn’t help to start with you may be offered a higher dose.

It’s rare for vaginal oestrogen to cause problems, but if you have any unexpected vaginal bleeding you should tell your GP. Your GP should explain that your symptoms may come back when you stop using it.

Vaginal oestrogen might be suitable for you if you can’t take HRT for medical reasons. Your GP should check this first with a healthcare professional specialising in menopause”.⁴

Who is a GP?

Dots and/or DotC (Depending on the Country) a GP may be a registered general practitioner, a medical practitioner, a medical doctor or a doctor.

Cream, Tablet, Pessary or Ring

How can estrogen be applied to the vagina?

In Menopause Management: Managing Vaginal Problems – Dry Vaginal Treatments: Vaginal Estrogen the (Australian) Jean Hailes for Women’s Health explain:

“Oestrogen can be applied directly to the vagina in the form of a cream, tablet or pessary”.⁵

In Menopause FAQs: Hormone Therapy for Menopause Symptoms – Q. What is hormone therapy? the North American Menopause Society (NAMS) explain for genitourinary syndrome of menopause (GSM):

“Vaginal estrogen therapy for GSM after menopause is administered into the vagina and is effective for moisturizing and rebuilding tissue. Very little goes into blood circulation, so the risks are far lower”.⁶

Vaginal Estrogen

Are all vaginal symptoms at this time, related to menopause?

On page two in Vaginal Dryness: Vaginal Estrogen Therapy the NAMS elaborate on:

“Government-approved low-dose vaginal estrogen products are available by prescription as vaginal creams (used two or three nights/week), a vaginal estradiol tablet (used twice/week), and an estradiol vaginal ring (changed every 3 months). All are highly effective. You may wish to try several different forms and choose the one you prefer”.⁷

Vaginal Symptoms

Are all vaginal symptoms at this time, related to menopause?

On page two in Vaginal Dryness the NAMS explain:

“Note: Vaginal symptoms not related to menopause include yeast infections, allergic reactions, and certain skin conditions, so consult your healthcare provider if symptoms do not improve with treatment”.⁸

Health Care Provider

What if I think I have vaginal dryness?

If you think you have vaginal dryness, it may be in your best interest to choose to talk to your health care provider about this.

On page one in Vaginal Dryness: Treatment Options the NAMS elaborate on:

“The good news is that effective treatment options, such as nonhormone remedies or different forms of low-dose estrogen applied directly to the vagina, are available. These can be combined for optimal symptom relief”.⁹

In Vulvovaginal Symptoms After Menopause the Australasian Menopause Society caution:

“Unlike some menopausal symptoms, such as hot flushes, which may disappear as time passes; genito-urinary problems often persist and may progress with time. Genito-urinary symptoms are associated both with menopause and with ageing”.¹⁰

The NAMS also note:

“You should discuss your individual risks and preferences with your healthcare team to determine whether hormone therapy or alternatives, including FDA-approved nonhormonal therapies, are right for you”.¹¹

What is FDA?

FDA can be an abbreviation for the (United States) Food and Drug Administration.

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Sources

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