Menopausal changes that don’t have to be

Menopausal changes that don’t have to be

In last Tuesday’s Science Times there was an article entitled, “Menopausal vagina monologues.” It was an excellent article talking about the fact that without any estrogen in menopause the vagina becomes atrophic. It loses blood supply and elasticity. It loses its normal pH (acid/base balance) because it cannot support the normal predominant bacteria called lactobacillus that feasts on glycogen and produces lactic acid, thus lowering the pH. Studies have shown that in terms of menopause-related hot flashes and night sweats, which can range from absent to mild to debilitating – that by 4-5 years into menopause 75-80% of women will have little or no symptoms. In other words, in most women such symptoms will eventually diminish. However, the opposite is true in the vagina. Women are spending 40% of their lives in a menopausal state. Other higher order primates (gorillas, chimpanzees) live perhaps only 1-2 years after they stop reproducing. It is unnatural to have a non-estrogenized vagina. And with time these changes from atrophy get more and more pronounced.

Recent studies have shown that as many as 50% of postmenopausal women are not aware that there are treatments that are safe to treat this atrophy. They believe this is just a function of, “getting older.” Thus, many women “suffer in silence” and, if still partnered, are experiencing painful intercourse.

I believe that some degree of sexual intimacy is important to a partnered relationship. It does not and should not have to hurt. There are very low dose estrogen creams, tablets and rings, which have been around for quite some time. One problem is the FDA insistence on “class labeling.” Vaginal estrogen is as little as 1/300th the oral dose used for hot flashes and night sweats. It is virtually not absorbed into the blood stream. It stays in the vagina. Yet because it is the same drug as what is given orally, the FDA gives it the same warnings. As past president of the North American Menopause Society, I helped write an editorial (link to editorial) and petition the FDA to modify that label and its unnecessary frightening warnings. They have not budged.

There is now one oral non-estrogen, which may have other beneficial effects in breast and bone, as well. There is also a local vaginal insert, which is DHEA (dehydroepiandrosterone). It is a non-hormonal but is, however, metabolized to estrogen and testosterone.

If you or anyone you know suffers from painful intercourse of menopause due to vaginal dryness and atrophy, please share this information with them.

I remain yours in health

Dr. Goldstein