Dear Dr. Roach: I need information about vaginal atrophy. I am 75 years old and have suffered for 2 1/2 years. I am in misery.
H.
Vaginal atrophy is a common condition of older women, or any woman who is more than a few years post-menopause. The lining of the vagina is dependent on estrogen to maintain its normal health. As estrogen levels decrease after menopause, the lining of the vagina can become thinned, leading to symptoms of dryness and discomfort. Women often find that sexual intercourse is painful. Recurrent urinary-tract infections might be the first way the problem is recognized. The vulva is affected, too, and in severe cases, the labia can even fuse.
I routinely see women with symptoms who haven鈥檛 been diagnosed. I don鈥檛 often see women who have been diagnosed and who are still suffering. The hard part, at least in my experience, is making the diagnosis: Some women don鈥檛 know to ask, or are embarrassed to do so, and some doctors don鈥檛 routinely ask or perform a regular examination. Once the diagnosis is made, treatment is straightforward and effective: an estrogen cream or gel usually does a good job of relieving symptoms and reducing urine infection risk.
Estradiol, the bioidentical female hormone, works well topically and is not absorbed very much into the blood, so it is considered safe. However, women with a history of estrogen-sensitive breast or uterine tumours absolutely should discuss use of vulvovaginal estrogen with the doctors taking care of these cancers. Men can be reassured that there is no risk to them, although one expert group recommends estrogen be applied at least 12聽hours prior to intercourse.
I am sometimes asked about laser treatment. Since I last wrote about vaginal atrophy, the U.S. Food and Drug Administration has issued a warning against laser devices that purport to treat symptoms or improve the appearance of the vulva and vagina.
The FDA warned, and the American College of Obstetricians and Gynecologists agreed, that the effectiveness of these devices is unproven and that they have the potential to cause serious harm, including burns and scarring that result in worsening pain. Until there is better data to support the efficacy and safety of these treatments, I recommend against them.
