Therapy For Vaginal Dryness And Atrophy!
By: Holly L. Thacker, MD • Posted on April 23, 2013
Have you Heard About Vaginal Atrophy?
Almost every day one sees an ad for “ED” also known as erectile dysfunction. Have you heard about VA? Vaginal atrophy that is. As for a counterpart ad for women, the lay public does not hear about treatments for “vaginal atrophy.” This is unfortunate because many women, even very educated women (as well as some health care providers) are completely unknowledgeable about vaginal atrophy, how common it is, and just how treatable it is. Because women cannot see their vagina, they cannot see the dramatic tissue changes that we women’s health physicians see on a daily basis.
This is a common and fortunately very treatable condition in ANY woman with low estrogen state. Low estrogen state is usually in postmenopausal women, but occasionally can occur in breastfeeding mothers as well as in any young woman who loses ovarian function. The lower half of the vagina, as well as the vulva, urethra (where urine comes out), and base of the bladder are all very estrogen sensitive tissues that can get pale, dry, red and raw and then contract without adequate sex hormones.
Vaginal Atrophy Treatments for Women
We have had many local vaginal treatments on the market for years that have included:
- Estrogen creams (such as Estrace/estradiol cream or Premarin/conjugated estrogen vaginal cream)
- Estrogen/estradiol tablets (such as Vagifem)
- Every 3 month local vaginal ring (Estring)
These are effective treatments for vaginal atrophy.
If vaginal atrophy is left untreated, it can lead to the following:
- Painful intercourse called dyspareunia
- Potential increase in bladder infections and overactive bladder
- Minor abnormalities in the pap smear termed ASCUS (atypical squamous cells of undetermined significance)
All of these conditions are well treated with local vaginal estrogen.
For women who cannot or will not take vaginal estrogen, we have recommended moisturizers such as:
- Replens over the counter
- Good ‘ol olive oil (in your pantry)
Both make for a nice moisturizer and lubricant.
For women with estrogen sensitive cancers like uterine cancer, off-label low dose vaginal DHEA can be compounded by a compounding pharmacist under your physician’s guidance. Most breast cancer survivors can use local vaginal estrogen (the doses are so low that if you swallowed an entire year of Vagifem - not suggesting you do, but if you did, the total dose of 104 tablets of vaginal estrogen tablets would be under one daily dose of estrogen for a postmenopausal woman!)
The First Oral Tablet for Vaginal Atrophy
Even though we have effective therapies that are safe and effective, simply put, many women just do not want to mess with putting creams, tablets, suppositories or a silastic ring in their vaginas. Enter the newest women’s health pharmaceutical product called Osphena (ospemifene), which is the first oral daily tablet to treat this condition. It is an estrogen agonist/antagonist like the SERM Tamoxifen (used to treat or prevent breast cancer) and Evista (used to treat osteoporosis and reduce breast cancer diagnosis). And like those agents, it carries a risk of the following:
- DVT (blood clot)
- Hot flashes
The Osphema treatment is not for everyone. However, be sure to be vigilant about vaginal health. If you have any symptoms of discomfort, dryness, decreased lubrication or sensation, please do not wait until you feel like you are sitting on shards of glass or that you feel like your skin has been ripped by rough sandpaper before you decide to come in for evaluation and treatment. In the words of our “Ask Nurse Mary,” Mary McDonnell, RN, “A healthy vagina is a happy vagina!”
-Be Strong, Be Healthy, and Be in Charge
Holly L. Thacker, M.D.
Holly L. Thacker, MD, FACP is nationally known for her leadership in women’s health. She is the founder of the Cleveland Clinic Women’s Health Fellowship and is currently the Professor and Director of the Center for Specialized Women’s Health at Cleveland Clinic and Lerner College of Medicine at Case Western Reserve University. Her special interests are menopause and related medical problems including osteoporosis, hormone therapy, breast cancer risk assessment, menstrual disorders, female sexual dysfunction and interdisciplinary women’s health. Dr. Thacker is the Executive Director of Speaking of Women’s Health and the author of The Cleveland Clinic Guide to Menopause.