I stopped taking estrogen about five years ago, and the biggest change I’ve noticed since then is that my vagina is undoubtedly drier. Not desert or sandpaper dry, but dry enough to take away the pleasure of sex, even masturbation. Lubricants help, but they’re temporary fixes. (It’s kind of refreshing to be able to be so straightforward about so many things at this stage in my life!)
When the gynecologist examined me a couple of months ago, I didn’t think to bring up the subject and she didn’t say anything, either. So I made an appointment with an endocrinologist I’ve seen for my bones and risk for diabetes, and she also happens to have a special interest in menopause. She had never brought up the issue of vaginal dryness, either, at my previous visits.
On this visit, the doctor first asked me a bunch of questions: Do I have hot flashes? Frequent urinary tract infections? Have I used lubricants? Is sex painful? When did I go off hormone therapy? Do I sleep ok? She also checked the meds and supplements I take, how much exercise I do, and the results of my blood chemistry, which I had checked a couple of months ago.
Then, I started asking the questions.
Geri: Why didn’t you or my gynecologist [in the same medical center] ever bring up vaginal dryness or other painful symptoms after menopause?
Dr. C: It should be talked about and elevated to an important issue in postmenopausal women. But when you have 15 minutes with a patient, and she has other issues, it is sometimes difficult to address it unless it is very pressing with her and she brings it up, or I’m treating her specifically for menopausal symptoms.
Geri: But if the patient doesn’t bring it up, and you don’t, it seems to me that she’s denying herself potential treatment, which she probably doesn’t even know about.
Dr. C: That’s right.
Geri: When do you prescribe therapy for vaginal dryness?
Dr. C: It really depends on how it affects your personal life. Is it bothersome throughout the day? Is it impacting intercourse? Are you getting frequent urinary tract infections? Those are all reasons to treat. The first treatment should be an over-the-counter treatment that’s not hormone based. But if that’s not working, it has been seen that local vaginal estrogen is effective and well tolerated in some women. It has some systemic absorption at the beginning of therapy, but it’s minimal.
Geri: How does it work?
Dr. C: The vaginal epithelium (the tissue lining the inside of the vagina) is thin at the beginning of local estrogen treatment, so the medication is systemically absorbed into the bloodstream in the beginning. Then the therapy maintains the vaginal epithelium.
Geri: What is the exact treatment?
Dr. C: There are vaginal creams, rings and tablets, but many women seem to like the tablets more. They’re less messy. The frequency of use depends on the extent of your symptoms. I’m going to write a prescription for you: for one tablet daily during the first two weeks of treatment, then twice-weekly use.
Geri: Thanks, Dr. C. All important to know.
To help you feel comfortable bringing up the subject, and to learn about available treatment options, visit www.vaginaldiscomfort.com/geri.
P.S. I am part of GLAM™ (Great Life After Menopause), a women’s health initiative sponsored by Novo Nordisk. As an alliance of FOF bloggers, we want to encourage all our FOFriends that it’s time to start speaking up about vaginal discomfort, seeking medical attention for symptoms and support from your friends and family.
This is the best time of our lives. Don’t let vaginal discomfort get in the way of the life you deserve. I didn’t. Nor should you.