Pelvic Symptoms after Menopause

October 25, 2018

 

The medical world has changed terminology for post-menopausal vaginal and urinary symptoms multiple times, so you may have heard the following terms:  atrophic vaginitis and vulvovaginal atrophy.  The newest term is genitourinary syndrome of menopause (GSM), and it’s preferred now because it takes into account not only the vaginal symptoms but also the urinary issues that can arise after menopause.  The lack of estrogen is what causes this group of symptoms.  GSM affects up to 50% of postmenopausal women. Hot flashes get better with time.  GSM is chronic and progressive.

 

Symptoms of genitourinary syndrome of menopause (GSM):

  • dryness, pain with intercourse, irritation, itching, frequent urination, sensation of needing to urinate urgency, incontinence, bladder infections

 

Treatment Options

 

Vaginal Moisturizers

  • One lecturer tells her patients to think of it like “face cream for the vagina”.  After your shower, you put our face moisturizer on your face and your vaginal moisturizer in your vagina.  A vaginal moisturizer is a non-hormonal option for women who are experiencing ongoing discomfort due to vaginal dryness or are experiencing painful intercourse. Vaginal moisturizers aim to replenish vaginal moisture on a long term basis.  They are available over the counter.  Moisturizers need to be used regularly (several times a week), rather than just around the time of intercourse. 

  • Some well-respected brands are:  Revaree (hyaluronic acid) vaginal suppository, Replens, Hyalo Gyn and Luvena 

 

Local Estrogen Therapy

  • Vagifem 10 mcg – inserted twice per week

  • Imvexxy 4 or 10 mcg – inserted twice per week

  • Estring - a vaginal ring that is inserted every 3 months

  • Estrace (estradiol) - a vaginal cream inserted twice per week

  • Compounded estriol cream - a vaginal cream inserted twice per week

 

Oral or topical full dose Estrogen Therapy

  • This is a great option for a woman who is in the “estrogen window” – within 10 years of menopause or before age 60.

 

DHEA (prasterone)

  • Intrarosa is the only brand approved by the FDA, but it’s also available at compounding pharmacies.  Prasterone is a precursor hormone which is produced in the adrenal glands, gonads, and brain and converted within cells into active metabolites of estrogens and testosterone.

 

Ospemifeme

  • The brand name is Osphena.  It is an oral pill that is a selective estrogen receptor modulator.

  • It has anti-estrogen effects on the breast.  It has not been studied in breast cancer survivors.

  • Among the approved SERMs, ospemifene is the only agent with a nearly full estrogen stimulating effect on the vaginal tissue while having neutral to slight estrogenic effects in the endometrium.

 

Topical Lidocaine 4% aqueous

  • This can be applied a few min before sexual activity

 

Vaginal Laser Therapies

  • Data are promising but we don’t have randomized controlled trials.

  • Laser therapies have not been approved by the FDA for GSM but is used off-label for this.

 

Lubricants

  • Lubricants only make the vaginal area slippery, not moisturized.  Use prior to intercourse.

  • Some brands are:  Good Clean Love Organic personal lubricant and Aloe Cadabra

 

 

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