vaginal atrophy

Wednesday Bubble me this: end the ‘silent suffering’

Posted by Liz on Oct 20, 2010 in estrogen, sexual health, vaginal atrophy | 12 comments

Bubble me this. When you think “chronic health condition,” what do you think of? I think heart disease, diabetes, multiple sclerosis or cancer. I don’t automatically think vaginal atrophy. And yet, it’s what’s for World Menopause Day.

The International Menopause Society (IMS) joined forces this year with Novo Nordisk FemCare Ag (marketers of Activella®) to ‘end silent suffering’ and promote recommendations for the management of vaginal atrophy during the menopause. A key problem, they say, is that results of a phone survey show that women are not discussing vaginal atrophy with their practitioners, who in turn, are not openly asking questions about vaginal health.

Vaginal atrophy refers to the thinning of the vaginal and vulvovaginal tissues due to a decline in estrogen, and can lead to pain, burning and soreness during sexual intercourse. Recent estimates suggest that vaginal atrophy affects about 50% of menopausal women. Symptoms can be mild or  severe, and unquestionably, the more a woman feels pain, the more she is likely to be distressed during intercourse or lose interest in sex altogether. What’s more, according to survey results, the majority of postmenopausal women incorrectly attribute vaginal atrophy symptoms to urinary tract and yeast infections. More importantly, the report notes that roughly 63% of surveyed women did not realize that vaginal atrophy was “a chronic condition requiring ongoing treatment of the underlying cause.”

A chronic condition requiring treatment?

Granted, a chronic condition is defined as a health problem lasting three years or longer. And depending on how long a woman’s menopause lasts, well, vaginal atrophy theoretically fits into that category. But aren’t we being a bit alarmist about the ‘silent suffering’ of women with this chronic condition?

Mind you, I am not mocking or doubting the horrible impact that vaginal atrophy can have on a woman’s life. In fact, aging and its accompanying aches and pains aren’t fun. Neither are hot flashes, night sweats, mood swings or vaginal pain. And I am heartened to see that the IMS has published recommendations for recognizing and managing vaginal atrophy. They include:

• Greater collaboration and open discussion with postmenopausal women about their vaginal health
• Early detection of vaginal atrophy
• The value of estrogen therapy in treatment, including HRT or preferably, vaginal tablets, cream or rings

According to these recommendations, lubricants and moisturizers are not universally recommended for use by themselves because they can be irritating and offer only temporary relief of symptoms. However, as Dr. Diana Hoppe points out in her book, Healthy Sex Drive, Healthy You, “to get the vagina adequately lubricated, I initially recommend lubricants [e.g. Replense or Astroglide]. If lubricants do not work to make sex more comfortable, I prescribe vaginal estrogen therapy, which comes in different forms.” The point that she makes is that it is important to consider lubrication issues (and the resulting atrophy) as something that can be addressed in a step-wise fashion. Nor does she discuss atrophy and dryness as if they are symptoms of a chronic condition. In fact, like Dr. Christine Northrup, Dr. Hoppe emphasizes that women’s health issues, in particular desire, are multifaceted and emotionally and physically related. Toward that end, is it possible that by focusing solely on the physiological aspects of atrophy, practitioners might miss other important factors?

The IMS recommendations also fail to mention selective estrogen receptor modulators (SERMS), which mimic the action of estrogen in the body but theoretically, without associated risks and side effects. Most importantly, while ‘localized’ estrogen (i.e. topically or vaginally applied) may have a better safely profile than systemic estrogens (which directly enter the bloodstream after being ingested or injected) it is not without risks; according to its package insert, Activella is associated with pain, headache, nausea, vomiting, irregular bleeding and thickening of the vaginal wall and and also has a boxed warning about heart disease, stroke and blood clotting.

There’s an inherent lesson here, which is why this piece is featured on Wednesday: by all means, seek help for vaginal atrophy but ask questions about the therapy your doctor or practitioner recommends. If your symptoms are severe, well, you might want to skip the lubricants and go for the big guns. And be sure to consider factors other than estrogen depletion that might be contributing to a declining libido. If there’s one thing that appears to permeate all women’s health issues, it’s this: nothing is as cut and dry as it seems.

I hardly believe that we’re on the verge of an atrophy epidemic or that we need to dramatize the “silent suffering” of countless women across the globe.

Bursting this one? Yeah, you bet.