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Vaginal Dryness

Estrogen from the ovaries keeps the vagina and vulva healthy. With menopause, the ovaries’ production of estrogen decreases significantly. This results in the vaginal and vulvar tissues becoming thin, dry, and less elastic. Other symptoms include burning, generalized discomfort, urinary urgency, recurrent bladder infections, and itching. Some women experience tearing of the tissues, particularly during sex, making it very uncomfortable.

Certain medications that lower estrogen, such as aromatase inhibitors used in breast cancer treatment, can further aggravate dryness/irritation symptoms. Unlike other symptoms of menopause, GSM worsens with time if untreated and can result in vaginal narrowing. While most menopausal women have some degree of GSM, only a small minority seek treatment for their symptoms. The great news is that many wonderful treatment options exist: Nonhormonal lubricants and moisturizers can be bought over the counter. Lubricants are typically used at the time of sexual activity, whereas moisturizers should be applied several times a week.

When non-hormonal treatments are not enough, vaginal estrogen therapy is recommended. Vaginal estrogen works by increasing blood flow to the vagina and improving vaginal skin thickness and elasticity. Vaginal estrogen comes in the form of creams, pills, and rings. The effect is almost entirely localized (where you put it is where the effect is), with minimal absorption into the bloodstream, which is why vaginal estrogen can usually be offered to a woman with a history of breast cancer after discussion with her oncologist.

Ospemifene is a prescription estrogen agonist/antagonist. This means that it stimulates estrogen effects in some areas like the vagina but has antiestrogen effects in areas such as the breast. This is a good option for women who do not want to take estrogen or use creams. Intravaginal dehydroepiandrosterone (DHEA) is a daily pill placed in the vagina that converts into estrogen and testosterone to treat GSM. It does not alter hormone levels in the blood and works locally within the vagina.

Regular vaginal intercourse, the use of vaginal dilators to help stretch the tissue, and physical therapy are all good modalities for treating symptoms associated with GSM.

Vaginal dryness and associated symptoms can be hugely detrimental to one’s quality of life but should not be ignored or accepted as a part of life. Thankfully, so many options exist to substantially improve one’s healthy aging.

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