Vaginal Atrophy: Is there an effective non-hormonal option?
While the GLAM squad works to convince you that the only sensible option to treat vaginal atrophy is Novo Nordisk’s Vagifem (a topical estrogen agent), I would like to share that a highly effective non-hormonal option exists. The rub? It’s only available in Europe and Canada. The thing is, I have tried it and while I may be an n of 1 in scientific circles, I want to share that it’s pretty darn amazing.
Before I do the reveal, I would like to get a bit personal and share my story. After years of experiencing no issues with vaginal dryness or pain during intercourse, the tables turned this past Summer. And so, I did the most sensible thing that I could do (short of reading Flashfree!); I made an appointment with my gynecologist. And after a thorough examination and a few tests for infections, she recommended that I try Estrace, another topical estrogen in the same category as Vagifem.
If you are a long time reader of Flashfree, you are well aware of how I personally feel about hormones. However, what I’ve not shared on this blog is that I have always had an extreme sensitivity to hormones, a sensitivity that I discovered in my early 20s when I started using the pill. That, coupled with the fact that my mother had breast cancer at an extremely early age made me wary of any type of hormone. And years later, when I started this blog and read all the data I could get my hands on, I was convinced that hormones were not a good route, regardless of their efficacy in addressing menopausal symptoms. Yet, regrettably I chanced it…again.
I want to emphasize that my experience is only mine and is not necessarily reflective of others’. However, within a month of using Estrace, I gained 6 pounds, was bloated, developed severe acne, had daily headaches, and experienced significant and irrational irritability. But damn, my vaginal tissues were once again moist.
Not. Good. Enough.
And so, I started researching my options. And stumbled across Gynatrof. 
Gynatrof gel is a natural topical agent comprised of microscopic beads (known as liposomes) are formulated to act as both a lubricant and a moisturizer. This technology helps to insure that the vaginal tissues remain moist between applications, and additionally, boosts hydration and elasticity. The gel contains several ingredients:
- Hyaluronic acid, a type of molecule found abundantly throughout the body’s connective tissue, the skin and the nervous tissues. Hyaluronic acid has the ability to store large quantities of water, thereby forming a natural, moisturizing liquid film when applied topically. More specifically, it helps to protect the vaginal skin from irritation and redness, itching and burning; enhances natural lubrication and may even help to aid healing of irritated vaginal tissue.
- Hops plant extract, which has weak estrogenic effects and may help promote lubrication and elasticity. Hops have also been shown to possess antibacterial properties and are sometimes used for leg ulcers.
- Vitamin E, which the manufacturer says reduces inflammation and prevents aging of the vaginal area. If anything, vitamin E is believed to be an antioxidant that may help prevent or treat disease. It has also been used for centuries to treat the skin and has been shown to penetrate both the outer and next layer of the skin (epidermis, dermis, respectively).
Available in Europe since 2006, Gynatrof has proven safe and there have been no reports of estrogen-related sensitivity. It is also non-toxic should it be accidentally ingested.
My personal experience? I have been using Gynatrof for a month now. And I have had stellar results – no side effects, no sensitivity and no issues during intercourse.
As someone who regularly colors outside the lines, it’s no surprise that I was able to obtain Gynatrof. But more importantly, when I contacted a local compounding pharmacy to see if they could obtain it for me, they called back after several hours to inform me that they could not.
This is an OTC product in both Europe and in Canada. It has been on the market for eight years now. And yet, we do not have access to it in this country. Moreover, it works, at least for me. And it is a safe option for women who either cannot tolerate hormones or choose not to use them.
Anyone interested in starting a petition? I cannot endorse this product enough.
[Disclosure: I neither contacted the manufacturer or its representatives nor did either contact me to review Gynatrof. It worked so well for me that I wanted to share it with my readers]
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Vaginal atrophy: an alternative to hormones
I have been a bit disturbed by the surge of attention in the menopause space to vaginal atrophy, i.e. thinning and drying of the lining of the vagina. Mind you, I don’t feel that impact that vaginal atrophy can have on a woman’s life should be marginalized, however, when I see my colleagues racing to write about hormones and ending the silent suffering of tens of thousands of women, all I can do is shake my head in disbelief; you see, my space is not for sale to any bidders. Let me be clear: vaginal atrophy affects roughly 43% of women during menopause and can lead to extreme discomfort, dryness, burning, itching, pain and lack of sexual desire. Since most women spend about a third of their lives in postmenopause, this can be a huge issue and one that warrants attention. However, to represent vaginal atrophy as an epidemic of epic and burgeoning proportions is simply irresponsible.
As I step off my soapbox, let me share the true reason for this post: Finnish researchers have discovered a potential treatment for vaginal atrophy for women who cannot use or choose to forgo systemic or topical estrogen therapy — sea buckthorn oil. Sea buckthorn oil is derived from the fruit of deciduous shrubs and has long been used in Central Asia to treat inflamed genital organs and uteri. When it is ingested, it has been shown in clinical studies to positively affect blood fats, dry eye, the aggregation of platelets that can cause heart disease and even reduce system-wide inflammation. Woo-woo? Hardly; my point is that sea buckthorn oil has been studied in scientifically-sound, clinical trials.
In a study published online in the journal Maturitas, 116 women were asked to take sea buckthorn oil (3 capsules, or 3 gm daily) or placebo for three months. Vaginal mucous membranes were examined both at the beginning of the trial and at the end and were analyzed for elasticity, integrity, moisture and fluid. The women were asked to score the severity of their symptoms — vaginal dryness, burning and itching — at the beginning, middle and end of the trial and also and also kept diaries on other menopausal symptoms.
Sea buckthorn oil was shown to significantly improve the integrity of the vaginal lining by about 50% compared to placebo; women taking the oil trended toward increases in their vaginal health index, which was a composite of all vaginal atrophy symptom scores (i.e. elasticity, integrity, moisture, fluid and pH). Sea buckthorn oil also appeared to decrease night sweats but did not appear to benefit other menopausal symptoms. Moreover, while the women taking the oil experienced improvements in their vaginal symptoms from the start to the end of the study, the difference compared to placebo was not significant enough to demonstrate the lack of a placebo effect and clearly, more research is needed. Another important finding was the lack of effect on cell types, which indicates that sea buckthorn oil does not have an estrogen effect. Finally, common side effects, which affected both groups about equally, included GI symptoms. Because sea buckthorn oil may slow clotting, it is not recommended that it be taken along with other agents that likewise, affect clotting, such as aspirin, ibuprofen and warfarin.
It is unclear whether or not topical use of sea buckthorn oil might provide greater comfort without some of the GI side effects. A quick search shows that it is readily available online and depending on the formulation, retails for anywhere from $12 to $30. As always, use caution and speak to a knowledgeable practitioner before starting any regimen with sea buckthorn oil. Most importantly, it is nice to know that researchers continue to explore avenues other than hormones for common conditions like vaginal atrophy.
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Wednesday Bubble: How Dry Am I? How Dry Are You?
Puzzle me this:
What do vaginal dryness and technology have in common?
Evidently, the folks at RuJuVey want your help in finding out. But first, let’s talk about the issue of vaginal dryness. Vaginal dryness is a characteristic of vaginal atrophy — a thinning of the vaginal tissue that results as estrogen declines. It affects as many as half of all women as they go through menopause and although vaginal atrophy can occur during anytime in a woman’s life, it’s prevalence does increase with aging. And so do the accompanying symptoms of dryness, pain during intercourse, irritation, post-intercourse bleeding and of course, a decline in sexual desire and functioning as a result. While topical estrogen is certainly an option and prescribed by many clinicians for this problem, it’s always nice to have non-prescription alternatives that work just as well.
That’s where RuJuVey theoretically enters the picture.
Admittedly, I don’t know very much about RuJuVey; from what I understand, the company is working on a device that uses sonic technology to deliver a non-hormone emollient. And, while the product is in development, they are seeking your assistance, via a short, online survey, to try to learn more about vaginal dryness and the percentage of women who suffer from it as a result of aging. In addition to participating in the survey, you may also be considered for participation in a test group.
Mind you, I’m curious about the device, although I’m not quite sure that I can get my ‘legs’ around (!) what I assume will be a tampon-like device that requires insertion to help turn on the juices again. Then again, that’s simply an assumption.
If you are interested, I’d encourage you to click on the link above and take the survey. I did and it’s a painless way to participate in innovation. And when it comes to menopause, I’m all about innovating.
Who knows? It might be the sunny side of Menopause Lane!
[Disclosure: While I was approached by ReJuVey to share their survey, they did not contribute ideas for this post nor was I paid by the company.]
Read MoreWednesday Bubble: Lub(e)-a dub dub
Vaginal atrophy — thinning and drying of the vaginal tissues as a result of declining estrogen levels– leads to itching, burning, dryness, irritation and pain. And while it certainly isn’t the silent scourge overtaking women globally, it does affect roughly 50% of menopausal women and often goes unrecognized and undiagnosed. More importantly, unlike hot flashes and night sweats, vaginal atrophy does not go away; rather, in some women, may may progress to cause years of discomfort, so much so that quality of life is significantly impacted. Indeed, data suggest that the proportion of women experiencing vaginal dryness increases five-fold as women advance through menopause.
Importantly, results of a recent global survey indicate that most women choose over-the-counter lubricants and are not even aware that a low-dose, relatively safe topical estrogen treatment is available. Still, for many, over-the-counter options are enough, such as Replens, which theoretically goes beyond instant relief and actually provides ongoing protection. However, what should you do if sexual intimacy continues to be uncomfortable, your vagina feels increasingly uncomfortable and hormones are an undesirable choice?
Isoflavones baby!
Yup, soon, you may be able to leave the over the counter and hormone therapy options behind for a safer, effective treatment. Reporting in the online version of Maturitas, researchers state that they have been exploring plant-like estrogens in a topical gel format can deliver benefits similar to topical estrogen gel without p0tential safety issues. And, when they blindly compared 12 weeks of a 1 gm isoflavone gel to topical Premarin or placebo gel in 90 menopausal women, that’s exactly what they found!
At the beginning of the study, 100% of women reported vaginal dryness and pain, 82% said that they had itching and 72% complained of vaginal discharge. In women receiving the isoflavone gel, as many as 70% reported that their dryness was intense and 60% said that their pain was intense. By the end of 12 weeks, improvements were seen in both vaginal dryness and vaginal pain; no women reported having intense symptoms and roughly half said that their symptoms were mild. Overall, roughly 97% of women using isoflavone gel saw improvements in both vaginal dryness and pain. Similar figures were observed in women using topical estrogen.
Now here’s the science geeky part. When the researchers took a closer look at the cells in the vaginal wall, they noted a shift towards values that one would see in a premenopausal woman. And, whereas topical vaginal hormone therapy sometimes results in vaginal bleeding and thickening of the lining of the uterus, these issues were not seen in women using the isoflavone gel (neither were they noted in women using topical estrogen, probably due to the extremely low dosage).
The researchers say that it appears that the isoflavone gel can be used safely without any risk of systemic absorption. Now? We need more studies so we can get this gel to market.
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Monday Review: Chase the dry away – Replens
As many as half of all women going through menopause may experience vaginal atrophy — a thinning of the vaginal tissues due at least in part to a decline in estrogen. Although vaginal atrophy can occur during anytime in a woman’s life, it’s prevalence does increase with aging. And so do the accompanying symptoms of dryness, pain during intercourse, irritation, post-intercourse bleeding and of course, a decline in sexual desire and functioning as a result. While estrogen is certainly an option and prescribed by many clinicians for this problem, it’s always nice to have non-prescription alternatives that work just as well.
One of those options is Replens®
Unlike many over the counter lubricants that are geared towards replenishing lost moisture, Replens does not offer an instant, fleeting solution to dryness just before intimacy, but rather, appears to provide lasting moisture. Consequently, its recommended use is every three days (or as needed), although it can be safely used daily.
Replens comes in a pre-filled applicator that theoretically places moisture where you need it most; deep within the vaginal canal. It doesn’t have an especially pleasant or unpleasant odor or taste, although it is a bit on the sticky side. According to the manufacturer, some women may experience ‘a residue or discharge after initial use,’ which they attribute to the elimination of dead skin cells that may build on vaginal tissue and say will dissipate over time with regular use.
Although the evidence supporting its use is a bit scant, there are some data from a very small study comparing Replens to topical estrogen therapy over 12 weeks that shows equivalent and significant improvement in moisture, fluid and vaginal elasticity as the vagina returned to a healthy pH state. These data were more recently quoted in a New England Journal of Medicine review. It appears to be safe and importantly, is compatible with natural rubber latex, polyisoprene and polyurethane condoms.
Admittedly, I am most impressed that the company that manufactures Replens also manufactures RepHresh Vaginal Gel, a product recommended/prescribed by my gynecologist that I’ve personally used on and off for years. RepHresh is indicated for maintaining a healthy vaginal pH and for Group B Step vaginal infections and is truly a fine product.
Got dry? You may want to try Replens before you turn to vaginal estrogen cream. It has a good price point – $16.99 for an 8 pack of prefilled applicators which if used as directed, lasts for about a month. The company is also offering a $3 off coupon on its website. Moreover, if you have questions about sex and intimacy that you have been dying to ask but don’t know where to turn, you can tap into an expert anonymously and free via their Facebook page.
Good company, great products, non-hormonal.
A perfecta trifecta to chase the dry away.
[Disclosure: a company representative contacted me via email and asked if I would like to try Replens. I was sent one box of product but was not reimbursed for this review.]
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Trick or…
treat?!
[Source: Pinup Babes]
It’s Halloween and I’ve got a treat for you. It’s called Intimina, a new line of feminine wellbeing products and information manufactured by the company responsible LELO. If you are unfamiliar with LELO, well, it’s time to get familiarized. LELO are intimate designer ‘lifestyle products’ that not only look good but are well designed, long lasting and rechargeable; I generally refer women and men to LELO first when discussions about adult massagers and intimate market items arise. In fact, I was introduced to LELO several years ago and never looked back. And while the price point is higher than what you might be accustomed to when it comes to vibrators, they are well worth the extra investment.
But I digress…
I received an email from an Intimina PR manager several weeks ago, inquiring if I would be interested in checking out their Intimina brand. When I read that they were attached to LELO (the co-founder is married to LELO Founder Filip Sedic), I didn’t hesitate for a second; I was already a major fan of theirs’.
According to the promotional material, “Intimina by LELO is an exciting new brand focused on providing women with the the very highest standard of products to supplement their intimate wellbeing…” Okay, sounds like standard PR jargon, right? However, I am very impressed by their product offerings, which range from unique Kegel exercisers to maintain and strengthen the pelvic floor to feminine moisturizers to their famous massagers (rebranded in pink, which admittedly, I am not crazy about but if the shoe fits…).
Most of you probably know that Kegel exercise is repetitive contracting and relaxing of the pelvic floor muscles (the vagina and ligaments that support the bladder) in order improve tone and strength, treat or prevent prolapse and stress urinary incontinence. The latter condition, which describes involuntary leakage of urine because the the muscles supporting the urethra don’t shut as tightly as they should, disproportionately affects women, increases with age, and often occurs after pregnancy. It is prompted by activity such as coughing, sneezing and heavy lifting – anything that places pressure on the bladder. Currently, as many as 15 million women in the US are affected by stress urinary incontinence, and with age, it may occur concurrently with overactive bladder, a condition associated with an uncontrolled urge to urinate, frequency of urination, incontinence and nighttime awakening to urinate.
Having never given birth, I’ve not given much thought to strengthening my pelvic floor muscles. However, I know many women who suffer from stress urinary incontinence. Consequently, I am going to try out the Intimina Kegel Exercisers and report back.
My treat. No trick!
Happy Halloween and stay tuned…
p.s. Treat yourself to a LELO product while you await the Intimina review. 0 fat, 0 calories, 100% pleasure.
Disclaimer: Intimina/LELO did not ask me to write about their product nor did they pay me to do so. They provided me with a free sample of the Kegel Exercisers, the Feminine Moisturizer and some background materials. I intend to give them a test drive simply because stress urinary incontinence is a huge problem in women, as is vaginal dryness as women age.
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