VAGINAL ATROPHY / GSM
When estrogen levels drop, whether through entering surgical menopause or because systemic HRT is not reaching vaginal tissues, many women will find that their vaginas aren’t feeling like they used to. This is called Vulvovaginal Atrophy (VVA). Vaginal Atrophy is when the vaginal walls lose hydration and become thinned, dry and inflamed. For many women this can be an extremely painful and disheartening symptom. It can make intercourse more painful and can start to affect the Urinary System. When vaginal atrophy starts to impact the urinary system it is called Genitourinary Syndrome of Menopause (GSM).
Symptoms of VVA (Vaginal Atrophy):
Thinning of vaginal walls
Small tears in the tissue
Pain during intercourse
Symptoms of GSM (Genitourinary Syndrome):
Burning or pain when urinating
Feeling the urge to urinate more often
Leaking urine when coughing, sneezing, etc.
Usually when one has GSM, they will also have Vaginal Atrophy. Most women in Surgical Menopause will find themselves dealing with this frustrating symptom even if they are taking enough hormone replacement therapy to alleviate hot flashes and other menopausal symptoms. The vagina often needs separate treatment from the rest of the body to help restore hydration and elasticity, and relieve pain.
Treatments for VVA or GSM: What can I use?
VVA or GSM is treatable, but treatment options are entirely dependent on the reason for your surgery, and we highly recommend you consult with your doctor to help figure out the appropriate treatment. Some commonly used treatments, listed from hormone free to hormonal, are as follows:
First Line: Vaginal Moisturizers
Vaginal Moisturizers are usually hormone free and offer a cooling and hydrating effect to vaginal tissues. Some common brands are Replens, KY Liquidbeads, RePhresh Vaginal Gel, Vagisil Prohydrate, and many more. These can all be found over the counter in most pharmacies or stores.
Second Line: Vaginal Lubricants
Vaginal Lubricants will help alleviate the pain and burning of intercourse. To begin with you should look for a silicone based lubricant, as water based lubricants tend to dry women out faster. If you are more sensitive you want to find a silicone-based, glycerin free lubricant. Avoid petroleum based lubricants if you are using condoms as it can weaken them and cause them to break.
Third Line: Vaginal Estrogens
Vaginal estrogens are amazing at restoring the vagina’s natural hydration and ecosystem. Estrogen used in the vagina can have some overall systemic effects on hormonal levels, however the effect is usually small, and women who are avoiding estrogen for cancer reasons should speak with their doctor to see if vaginal estrogen is an option for them. Vaginal estrogens can include any of the following options.
Vaginal Estrogen Cream: Some common options are Estrace Cream, Premarin Cream, or a compounded cream from a Specialty Pharmacy. Vaginal creams are usually applied in a “loading” dose for a few weeks, and then only applied every second or third night. It can take up to 6 weeks for the creams to make a noticeable difference, but once it starts working it can be one of the most effective ways to treat VVA or GSM. Once those tissues start to plump and fill out, any urinary symptoms should start to decrease and eventually be eliminated.
Vaginal Estrogen Tablet: Vaginal estrogen tablets are well known under the name Vagifem, and the suppository is placed into the vagina using an applicator. Vagifem also uses a couple weeks “loading” dose, and after that period, an every other day maintenance dose is used.
Vaginal Ring: There is a vaginal ring that is used solely for vaginal atrophy. It goes under the name Estring, and is placed by you or your dr at the top of the vagina and slowly releases a consistent amount of estrogen to the vaginal area. Some women find the rings uncomfortable or have had a difficult time keeping them in place. Estring should not be confused with the vaginal ring, Femring, which is a systemic (entire body) HRT.
Fourth Line: If you are a woman who can not use Vaginal Estrogen due to a cancer diagnosis, or have found the above options don’t offer enough relief, there is a 4th option. The MonaLisa Touch is a newer treatment for VVA and GSM. We have been hearing some positive reviews regarding this procedure. It is costly, and we are not sure if it is covered by insurance at this time.
“MonaLisa Touch is a painless and minimally invasive laser treatment for vaginal rejuvenation. By gently acting on the tissue of the vaginal mucosa, the laser stimulates the production of collagen, improving the functionality of the treated area and restoring the proper trophies balance to the mucous membrane.” - Quoted from the MonaLisa Touch website
As you can see, there are a lot of treatment options for VVA or GSM. Keeping the vaginal tissues healthy and strong will help prevent this condition.