Q: Since menopause, I’ve had vaginal dryness, itching, and burning. Is there anything besides taking hormones that can help this?
According to one survey, 60% of women experience vaginal dryness or discomfort after menopause. Taking an anti-estrogen medicine like tamoxifen or an aromatase inhibitor for treatment or prevention of breast cancer also causes vaginal symptoms like these. Too often, women won’t mention it to their doctor because they’re either too embarrassed to bring it up or assume that nothing can be done anyway.
Without estrogen, the cells that line the vagina and birth canal begin to shrink. This makes the vagina less elastic and less able to secrete lubricating fluids, leading to vaginal dryness, itching, burning, pain, and bleeding during sexual intercourse.
Vaginal secretions are vitally important, not just for enjoying sexual activity but also for maintaining an optimum level of vaginal acidity, which supports “friendly” bacteria like lactobacillus. The right amount of vaginal acidity helps discourage yeast infections.
Many different types of bacteria live on our skin, in our mouths, intestines, and vaginal area. Some are helpful, but others can infect us. With only so much space and nutrients available, bacteria compete with each other for food and space to survive and reproduce. Having lactobacillus in your vaginal area leaves less room for “bad” bacteria and protects you from the vagina’s bacterial infections.
Can vaginal atrophy and discomfort be treated? Yes, with available estrogen and non-estrogen treatment options. Non-estrogen options include a long-acting vaginal lubricant, like Replens®, either by itself or with a personal lubricant right before sexual contact. You’ll find many choices available today for personal lubricants besides the old standby, K-Y Jelly®.
Replens® is a fragrance-free, long-acting moisturizing vaginal gel that supplies up to 3 days of moisture between applications. It’s available without a prescription in premeasured doses inside individual plastic applicators or as a tube with one reusable applicator.
Unlike estrogen, Replens® won’t change your vaginal cells, the pH of your vagina, or restore its lactobacillus. It provides lubrication that can ease the burning and make intercourse more comfortable but can cause some extra vaginal discharge during the first week of use as old cells slough off and come out, like cottage cheese.
Another way to relieve vaginal dryness is to replace the estrogen your body isn’t making any more. Taking an estrogen pill or patch, or even a small amount of estrogen cream directly applied to vaginal cells restores elasticity and lubricating secretions. It changes the acidity back to optimal levels.
Can a breast cancer survivor safely use locally applied estrogen to reverse her symptoms of vaginal atrophy? The evidence suggests YES. You don’t need to use much estrogen when applied directly to vaginal cells. When used at approved doses, locally applied estrogen doesn’t create detectable estrogen levels in the blood or affect endometrial and breast tissue.
Locally applied estrogen is only available as a prescription. There are estrogen vaginal creams that come with an applicator (Premarin®, Estrace®), vaginal tablets with individual applicators (Vagifem®), and a gelatin ring that releases estrogen (Estring®). The cream and vaginal tablet are used once daily at bedtime for a week, then twice a week for maintenance.
There are actually 3 different vaginal ring products that contain estrogen, each for a different purpose. Estring® is used for vaginal atrophy and includes the least amount of estrogen. Each Estring is worn for 90 days. Femring® has two strengths available to relieve hot flashes and other menopause symptoms and is worn for 90 days at a time. A third vaginal ring, NuvaRing®, is used for birth control.
There are two other prescription medicines designed to relieve vaginal discomfort. Osphena® is a pill taken daily that mimics estrogen in vaginal tissue while blocking estrogen action in breast tissue, similar to how tamoxifen works. It helps mild to moderately painful intercourse caused by vaginal dryness.
Intrarosa® is a new medicine for moderate to severe symptoms of painful intercourse due to vaginal dryness. A form of DHEA (dehydroepiandrosterone), it’s a bullet-shaped tablet you insert into the vagina every night. Although not studied in breast cancer, it doesn’t raise estrogen levels above those of healthy premenopausal women.
If you have significant vaginal burning and discomfort, see your doctor to rule out infection or other medical issues and discuss locally applied estrogen or one of the newer medicines as a possible option. Non-estrogen Replens® is available without a prescription.
