Question: I'm postmenopausal and often have vaginal dryness, which makes intercourse painful. Is there anything I can do about it?

Answer: Vaginal dryness can be a problem for many postmenopausal women. Vaginal dryness is a hallmark sign of the genitourinary syndrome of menopause, also known as atrophic vaginitis or vaginal atrophy. With this condition, vaginal tissues become thinner and more easily irritated — resulting from the natural decline in your body's estrogen levels during menopause.

To remedy vaginal dryness and painful intercourse (dyspareunia) associated with the genitourinary syndrome of menopause, your doctor might recommend:

• Vaginal moisturizers (K-Y Liquibeads, Replens, others), applied every few days to moisturize and keep vaginal tissues healthy.
• Vaginal lubricants (Astroglide, Jo, Sliquid, others), applied at the time of sexual activity to alleviate pain during intercourse.
• A low-dose vaginal estrogen cream, tablet or ring, to reinvigorate vaginal tissues. Even if you're using systemic hormone therapy pills or patches, your doctor might recommend a low-dose vaginal estrogen treatment if vaginal dryness and related symptoms persist. If you've had breast cancer, talk with your doctor about the risks of vaginal estrogen therapy.
• Ospemifene (Osphena), a selective estrogen receptor modulator (SERM) medication taken by mouth is used to treat painful intercourse associated with vaginal atrophy. This medication isn't recommended for women who have had breast cancer or who are at high risk of breast cancer.
• Dehydroepiandrosterone (DHEA), in the form of a nightly vaginal suppository is a treatment that may ease painful intercourse in menopausal women.

Regular sexual activity or vaginal stimulation — with or without a partner — also helps maintain healthy vaginal tissues in women after menopause.

This article is written by Shannon K. Laughlin-Tommaso, M.D., and Mayo Clinic Staff. Find more health and medical information on mayoclinic.org.

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Breast cancer and its treatments can cause many changes in your body. In addition to breast-related changes, you might also experience menstrual changes, hair loss or skin changes. In some cases, these changes can cause sexual challenges.

Vaginal atrophy, a thinning, drying and sometimes irritation of the lining of the vaginal walls, can be one of these challenges.

Vaginal atrophy is common as women age, but it can be worsened in women who've had breast cancer and are receiving endocrine treatments like tamoxifen or aromatase inhibitors.

Other situations that can result in vaginal atrophy include surgically induced menopause, and certain radiation therapies and chemotherapies.

Vaginal atrophy can make intercourse painful due to vaginal dryness or irritation and decreased lubrication. It can also lead to urinary symptoms like burning with urination, urinary urgency, incontinence and urinary tract infections.

Finding relief for vaginal dryness

When you've had breast cancer, non-hormonal options are the first choice for managing vaginal atrophy. This is particularly true if you've had a hormone dependent (estrogen and progesterone receptor positive) cancer. These options include:

• Vaginal moisturizers. Over-the-counter products like K-Y Liquibeads, Replens and Sliquid Satin can be used to restore moisture to the vaginal walls. These are typically applied several times a week, usually at bedtime.
• Lubricants. These nonprescription products improve discomfort from intercourse by reducing friction.Organic water-based or silicone-based hypoallergenic lubricants — like Yes, Jo and Sliquid — are less likely to cause vaginal irritation than are products that contain oil. Avoid products containing Vaseline.
• Allowing time for arousal. The natural lubrication created from sexual arousal can help reduce symptoms.
• Vaginal DHEA (prasterone). Talk to your cancer specialist about weighing the pros and cons of the different types of estrogen therapy.

Systemic hormone therapy generally isn't recommended. And cancers that are hormonally sensitive may also limit the use of vaginal estrogen options. This is especially true for women using aromatase inhibitor therapy to reduce the risk of cancer recurrence.

If your symptoms are bothersome even after trying the above steps, ask your health care provider about other options that may help. He or she can help you weigh your individual risks and decide on a specific plan.

If you have a history of breast cancer, tell your health care provider and consider these options:

• Nonhormonal treatments. Try moisturizers and lubricants as a first choice.
• Vaginal dilators. Vaginal dilators are a nonhormonal option that can stimulate and stretch the vaginal muscles. This helps to reverse narrowing of the vagina.
• Vaginal estrogen. In consultation with your cancer specialist (oncologist), your doctor might recommend low-dose vaginal estrogen if nonhormonal treatments don't help your symptoms. However, there's some concern that vaginal estrogen might increase your risk of the cancer coming back, especially if your breast cancer was hormonally sensitive.
• Systemic estrogen therapy. Systemic estrogen treatment generally isn't recommended, especially if your breast cancer was hormonally sensitive.

This article is written by Mayo Clinic Staff. Find more health and medical information on mayoclinic.org.

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ANSWER: Vaginal atrophy — a thinning, drying and sometimes inflammation of the vaginal walls — is one of the most common challenges women face after menopause. It’s believed that atrophy of vaginal tissues affects up to half of these women. There are a number of things you can try to lessen your symptoms.

Vaginal atrophy occurs when the estrogen levels in your body drop, usually after menopause. The condition may make intercourse painful due to vaginal dryness or irritation, and decreased lubrication during sex. In addition, it often leads to distressing urinary symptoms, such as burning with urination, urinary urgency, incontinence and urinary tract infections. Hence, the newer term for vaginal atrophy is genitourinary syndrome of menopause.

Some women may begin to notice symptoms in the years leading up to menopause. Others may not experience a problem until several years into menopause. In addition to naturally occurring or surgically induced menopause, certain radiation therapies, anti-estrogen hormone therapies and chemotherapies for cancer also may affect estrogen levels enough to cause vaginal and urinary changes.

For women who experience vaginal dryness or irritation, there are actions and products that can help. First, try a vaginal moisturizer. Over-the-counter products such as K-Y LiquiBeads, Replens and Sliquid Naturals Satin can be used to restore moisture to the vaginal walls. These products are applied several times a week, usually at bedtime.

In addition, nonprescription hypoallergenic water- or silicone-based lubricants can improve discomfort from intercourse by reducing friction. Choose products that don’t contain glycerin or preservatives, since women who are sensitive to these substances may experience burning and irritation. Avoid products containing petroleum jelly, such as Vaseline.

If your symptoms are bothersome even after trying vaginal moisturizers and lubricants, don’t hesitate to talk to your health care provider about other options. In particular, vaginal estrogen therapy is the most effective treatment for moderate to severe atrophy symptoms. Vaginal estrogen therapy may come in the form of a cream, ring, tablet or softgel that’s inserted into the vagina.

Vaginal estrogen is formulated in a much lower dose, compared to systemic estrogen. Vaginally applied estrogen is readily absorbed by the local tissues, resulting in minimal absorption of estrogen in the bloodstream. This is particularly favorable in situations where systemic estrogen is likely to have a higher risk of side effects, as in women with a prior history of blood clots. Vaginal estrogen also can be used in some women with a previous history of breast cancer, but this is a complex decision that needs to involve a patient’s oncology team.

Systemic estrogen therapy delivered as a patch, gel or pill, or vaginal ring, is formulated to provide estrogen to the whole body. Due to the systemic exposure to estrogen with this route, it is not the preferred therapy if the only indication for estrogen is vaginal atrophy. However, systemic estrogen therapy can be used as first-line treatment in women experiencing hot flashes, night sweats and vaginal dryness at the same time.

Genitourinary syndrome of menopause can involve the urinary system and cause bladder urgency, urge incontinence and predisposition to recurrent urinary tract infections. Vaginal estrogen can relieve these symptoms and improve women’s quality of life. Some women also experience stress incontinence during menopause. Pelvic floor exercises, commonly known as Kegels, can strengthen the muscles that support the uterus and bladder, and may relieve symptoms of stress incontinence.

Advanced vaginal atrophy may lead to uncomfortable intercourse. If this occurs, talk to your health care provider. In addition to vaginal estrogen, lubricants and moisturizers, your provider may recommend additional treatments, including vaginal dilators and a referral to a pelvic floor physical therapist for the treatment of painful intercourse. If possible, maintaining a level of sexual activity is an effective way to optimize vaginal health, as it improves blood flow to the vagina and keeps the tissues more elastic. (adapted from Mayo Clinic Health Letter) — Dr. Richa Sood, Menopause and Women’s Sexual Health Clinic, Mayo Clinic, Rochester, Minnesota

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Related Articles

• Women’s Wellness: Signs and symptoms of vaginal health problems published 6/21/18
• Stephanie Faubion, M.D., talks genitourinary syndrome of menopause published 12/1/17

The post Mayo Clinic Q and A: Managing the symptoms of vaginal atrophy appeared first on Mayo Clinic News Network.

According to The North American Menopause Society (NAMS), up to 45 percent of postmenopausal women find sex painful, but fewer than a quarter of those women seek treatment. Part of the reason women stay quiet might just be the name used to describe the condition — vaginal atrophy. To combat the stigma, the NAMS and the International Society for the Study of Women's Sexual Health have introduced a new medical term — genitourinary syndrome of menopause (GSM) — in the hope that it will encourage more women to seek treatment. On Mayo Clinic Radio, women's health expert Dr. Stephanie Faubion discusses GSM and other menopause-related problems. Also on the program, care coordinator nurse RoxAnne Brennan explains the EMERALD program for treating adolescent depression. And, a Mayo Clinic patient shares his heart transplant story.

The post #MayoClinicRadio Podcast: 8/13/16 appeared first on Mayo Clinic News Network.

Here's the Mayo Clinic Radio podcast.

The post The Stigma of Vaginal Atrophy: Mayo Clinic Radio appeared first on Mayo Clinic News Network.

According to The North American Menopause Society (NAMS), up to 45 percent of postmenopausal women find sex painful, but fewer than a quarter of those women seek treatment. Part of the reason women stay quiet might just be the name used to describe the condition — vaginal atrophy. To combat the stigma, the NAMS and the International Society for the Study of Women's Sexual Health have introduced a new medical term — genitourinary syndrome of menopause (GSM) — in the hope that it will encourage more women to seek treatment. On the next Mayo Clinic Radio program, women's health expert Dr. Stephanie Faubion will discuss GSM and other menopause-related problems. Also on the program, care coordinator nurse RoxAnne Brennan will explain the EMERALD program for treating adolescent depression. And, a Mayo Clinic patient shares his heart transplant story.

Listen to the program on Saturday, Aug. 13, at 9:05 a.m. CDT, and follow #MayoClinicRadio.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Mayo Clinic Radio: The Stigma of Vaginal Atrophy appeared first on Mayo Clinic News Network.

Listen to the program on Saturday, Aug. 13, at 9:05 a.m. CDT.

Miss the show?  Here's the Mayo Clinic Radio podcast.

Follow #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

Access archived shows.

The post Mayo Clinic Radio: Vaginal Atrophy / EMERALD Program / Heart Transplant Patient Story appeared first on Mayo Clinic News Network.

ANSWER: What you are experiencing is common. By some estimates, loss of lubrication and elasticity in the vaginal area (vaginal atrophy) affects at least half of women in midlife and beyond. Systemic hormone therapy — taken as an oral pill or a skin patch — isn’t the only treatment for menopausal vaginal atrophy. Other treatments are specific for vaginal atrophy. In fact, if you experience only vaginal symptoms related to menopause, without hot flashes and night sweats, these other therapies are probably better choices.

Vaginal atrophy is caused by a decrease in estrogen production. As you approach menopause, your body’s production of estrogen — the main female hormone — ebbs and flows and eventually decreases permanently. Less estrogen can make your vaginal tissues thinner, drier, less elastic and more fragile. Estrogen reduction and vaginal atrophy may also occur as the result of certain medical treatments, such as the removal of both ovaries, pelvic radiation, chemotherapy or hormonal treatment for breast cancer.

For some women, vaginal atrophy due to menopause may begin during the years leading up to menopause. For others, it may not become a problem until several years into menopause. Some women are never bothered by it.

Signs and symptoms of vaginal atrophy often include dryness, soreness, itching, burning, bleeding and pain during sex. Vaginal atrophy can also be a risk factor for an overactive bladder, stress incontinence and repeated bladder infections. And unlike hot flashes and night sweats — which tend to eventually go away on their own — vaginal atrophy can worsen without treatment. Left untreated, changes to vaginal tissue — such as a narrowed opening, loss of elasticity and easy bleeding — can become permanent. Worsening atrophy can lead to avoidance of sex, which can lead to further atrophy.

For mild symptoms, the first thing you might try is vaginal moisturizers and lubricants, which are available without a prescription. Vaginal moisturizers used every few days can help maintain the moisture of vaginal tissues. Lubricants can be used as needed for sexual activity. Vaginal lubricants can help decrease pain during sexual activity and can be applied as often as needed during sex. If you’re using condoms, avoid lubricants that aren’t listed as safe with condoms.

Regular sexual activity itself helps to maintain active blood flow to the vagina and helps produce vaginal lubrication. Stimulation with a lubricated vaginal dilator or vibrator also may help maintain vaginal health and prevent or reverse vaginal narrowing.

If nonhormonal therapies aren’t enough to relieve symptoms, your doctor may recommend a vaginal estrogen cream, tablet or ring. These use a much lower dose of estrogen than do systemic hormone therapies and thus limit your overall exposure to estrogen and its associated risks. Vaginal estrogen therapies help to reverse vaginal tissue changes by restoring the vagina’s normal pH balance, thickening surface tissue, increasing blood flow and lubrication. They can also help reduce urinary tract infections and overactive bladder symptoms. Vaginal estrogen therapies typically work better for moderate to severe symptoms than do nonhormonal therapies or even systemic hormone therapy.

An oral estrogen tablet is available for women who don’t want to use a vaginal product; however, it isn’t approved for those with or at high risk of breast cancer or who have had a uterine cancer.

Don’t put off seeking help for vaginal atrophy. There are treatments that can help you feel better and prevent complications. Talk to your doctor to determine if one of them may work for you. (adapted from Mayo Clinic Health Letter) — Mary Marnach, M.D., Gynecology, Mayo Clinic, Rochester, Minn.

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January 4, 2013

Dear Mayo Clinic:

What exactly is vaginal atrophy? Are there any effective treatments for it, or is it just another part of aging that I will have to live with?

Answer:

Vaginal atrophy (atrophic vaginitis) is the thinning and inflammation of the vaginal walls and lower urinary tract due to a lack of estrogen. The condition typically occurs in perimenopausal or menopausal women and can cause vaginal itching and discomfort during intercourse. By some estimates, about half of postmenopausal women experience vaginal atrophy. Though some women do not seek help, there are a number of treatment options for vaginal atrophy that can offer relief.

With vaginal atrophy, lower levels of estrogen make the vaginal tissues thinner, drier, less elastic and more fragile. The condition can develop anytime a woman's estrogen production declines, including the years leading up to and after menopause, after childbirth, during breast-feeding, after the surgical removal of both ovaries, after pelvic radiation or chemotherapy for cancer, or as a side effect of breast cancer hormonal treatment.

The symptoms of vaginal atrophy can vary from moderate to severe, and might include dryness, burning, discomfort during intercourse and light bleeding after intercourse. Burning with urination, urgency with urination, urinary incontinence and frequent urinary tract infections also might occur. The thinning of the vaginal walls and changes in the acidity of the vagina caused by vaginal atrophy also can increase the risk of vaginal infections.

Symptoms of vaginal atrophy might be more intense if you smoke, if you've stopped having intercourse for a prolonged time and resume it again, if you've had vaginal surgery, or if you've never given birth vaginally.

Your doctor can diagnose vaginal atrophy by performing a pelvic exam and, if you have urinary symptoms, by ordering a urinalysis to rule out any other possible conditions, such as a urinary tract infection.

For mild vaginal dryness or irritation, regularly applying a nonprescription vaginal moisturizer (Me Again, Replens, Silk-E, others) can restore some moisture to the vaginal area. A nonprescription water-based lubricant (Astroglide, K-Y, others) can reduce friction and discomfort during intercourse. Try different products to find a treatment that suits your needs. If you use condoms or a diaphragm, avoid oil-based lubricant products, which can damage these types of contraceptives.

Sexual activity also can ease the symptoms associated with vaginal atrophy. This is likely a result of enhanced blood flow to the vagina, which helps keep vaginal tissues healthy. If vaginal intercourse is painful, give yourself plenty of time to become aroused and consider use of a personal lubricant.

For moderate or severe symptoms, topical (vaginal) or systemic (oral, transdermal or higher dose vaginal application) estrogen can relieve vaginal dryness and itchiness and improve vaginal tissue elasticity. However, your doctor might caution against use of systemic estrogen if you have a history of breast cancer or other hormonally sensitive cancers.

If estrogen therapy is an option for you, expect noticeable improvements after a few weeks of use. Severe symptoms might take months to improve. Side effects of estrogen therapy, while uncommon, might include vaginal bleeding or spotting or breast tenderness. Hormone therapy can also cause nausea, bloating, headaches, dizziness and mood changes although these side effects generally occur mainly with systemic use of hormone therapy. Ask your doctor what to expect.

Topical estrogen is more effective than systemic estrogen at treating vaginal atrophy and limiting your overall exposure to estrogen. Estrogen applied to the vagina can still result in estrogen reaching your bloodstream, but the amount is significantly lower than with systemic estrogen treatment. Generally it appears safe to use small amounts of vaginal estrogen in women with a history of breast cancer. Vaginal estrogen therapy comes in several forms.

Although symptoms of vaginal atrophy can be frustrating, one of these treatment options may work for you. Talk to your doctor to determine which type of treatment is best for your circumstances.

— Mary Marnach, M.D., Obstetrics and Gynecology, Mayo Clinic, Rochester, Minn.

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