A few years prior to menopause there is a decrease in the level of estrogen which causes a number of changes in the vulvar and vaginal area. This is known as “vulvovaginal atrophy” and symptoms include dryness, pain, itching, irritation and painful intercourse. Some women may also experience difficulty voiding and worsening urine leakage. Women spend almost one third of their lives in the menopausal years and therefore without estrogen. About 40% of these women complain of symptoms related to vaginal dryness. Although the use of systemic estrogen will improve this condition, many are reluctant to use hormonal replacement therapy due to the slight increased associated risk of breast cancer. Local estrogen formulation is now the first choice for the management of vulvovaginal atrophy. Treatments available include creams, tablets and vaginal rings. The systemic absorption of these preparations is minimal and does not seem to affect the breast tissue. However, the safety of these medications in breast cancer survivors has not been fully established, and may be associated with an increased risk of breast cancer recurrence. In my practice, I counsel women everyday about the benefit of starting local estrogen prior to experiencing any of these symptoms. Once this condition is established, it takes an average of 3 months of treatment before a noticeable improvement in symptoms occurs. Many women rely on over-the-counter gel based preparations. However these treatments do not help to prevent the loss of the elastic component of the vaginal tissue and therefore do not prevent prolapse of the uterus and the vagina. New formulations are currently being researched, some of which are hormone-free, and should become available in the next few years.
If you are experiencing any of these symptoms or are approaching menopause and concerned about preventing vulvovaginal atrophy, discuss your options with your physician and be open minded about the use of vaginal estrogen.