QUESTION: I am an active woman in my late sixties and have had a healthy life, so this problem is cause for concern. I have developed a vaginal itch, which my doctor has blamed on the “mature woman's syndrome” and prescribed Synapause vaginal cream for. My gynaecologist prescribed the same cream.
I, however, read the pamphlet and realised it is HRT (hormone replacement therapy) and will not use it. My mother at the age of 45, my sister at age 60 and my niece at age 40, all had mastectomies. Because of this family history, l have never taken HRT.
I then went to a homeopathic doctor who gave me some natural HRT cream, but after nearly three months it is no better. Have you any remedies that you can give me; l really can't go through life like this and will not take any prescription HRT.
ANSWER: You are not alone in avoiding taking HRT. It seems so paradoxical that the hormones that are involved with fertility and optimising the female body for reproduction, are reduced in ageing and lead to unbearable secondary medical issues like atrophic vaginitis.
What exactly is atrophic vaginitis?
Atrophic Vaginitis involves redness, itching, and dryness of the vagina. Over time there may be narrowing and shrinkage of the vaginal opening and the vagina itself. It occurs in up to 70 percent of post- menopausal women as a result of decreased oestrogen levels.
So why all the hype about oestrogen?
A woman's ovaries make oestrogen until menopause, which can occur anywhere between 45 and about 55 years of age for most women. Before menopause, oestrogen in a woman's bloodstream helps keep the skin of the vagina healthy and stimulates vaginal secretions. After menopause, when the ovaries stop making oestrogen, the walls of the vagina become thin, and vaginal secretions are lessened. Similar changes can happen to some women after childbirth, but in this case these changes are temporary and less severe.
Is it curable and what are the options?
It is a treatable condition, but not without challenges. Replacing oestrogen remains the mainstay of treatment especially if other conservative medications fail to relieve symptoms.
One must remember that not all women present in the same way and over the same time period. The degree of dryness, discomfort and even infection and pain can vary dramatically. The timeline is unique for every woman.
Approach to treatment
Variable causes mean that you should visit the doctor before self-treating your symptoms. Causes include decreased oestrogen, an infection, irritant, or other reasons.
* For mild symptoms, relief is sometimes achieved by using a water-soluble vaginal lubricant.
* Petroleum jelly, mineral oil, or other oils should be avoided as they can increase the risk of infection and damage latex condoms or diaphragms.
* Vaginal moisturisers (Replens, Vagisil Feminine Moisturiser) can restore some moisture to your vaginal area. Compliance with application every two to three days is essential. The effects of a Moisturiser generally last a little longer than those of a lubricant.
* Choose products that don't contain glycerine because women who are sensitive to this chemical may experience burning and irritation.
* Hormone replacement therapy (HRT) can be taken as a tablet, gel, patch or implant, which supplies oestrogen to the whole body. Although effective there is much debate about long term risks and worsening of breast cancer. Certain breast cancers are very oestrogen sensitive and thrive when HRT is used. Consultation with your oncologist and gynaecologist is always advised if there is a history of breast cancer in your family or if you previously have had breast cancer.
* Local preparations also exist and low dosages are less frowned upon - vaginal tablets, creams, rings and pessaries can be taken internally to supply oestrogen to the vaginal area only. Vaginal oestrogen has the advantage of being effective at lower doses and limiting your overall exposure to oestrogen because less reaches your bloodstream. It may also provide better direct relief of symptoms than oral oestrogen does.
* Regular exercise is important as it keeps blood flow and genital circulation high.
* Experimenting with your diet can also prove effective. Soy isoflavones (plant oestrogens), linseeds, fish oils, and black cohosh have been found to be helpful.
No ‘one-size fits all’ solution so consult your doctor
Variable causes mean that you should visit the doctor before self-treating your symptoms. Causes include decreased oestrogen, an infection, irritant, or other reasons.
l For mild symptoms, relief is sometimes achieved by using a water-soluble vaginal lubricant.
l Petroleum jelly, mineral oil, or other oils should be avoided as they can increase the risk of infection and damage latex condoms or diaphragms.
l Vaginal moisturisers (Replens, Vagisil Feminine Moisturiser) can restore some moisture to your vaginal area. Compliance with application every two to three days is essential. The effects of a moisturiser generally last a little longer than those of a lubricant.
l Choose products that don’t contain glycerine because women who are sensitive to this chemical may experience burning and irritation.
l Hormone replacement therapy (HRT) can be taken as a tablet, gel, patch or implant, which supplies oestrogen to the whole body. Although effective there is much debate about long term risks and worsening of breast cancer.
Certain breast cancers are very oestrogen sensitive and thrive when HRT is used. Consultation with your oncologist and gynaecologist is always advised if there is a history of breast cancer in your family or if you have had breast cancer.
l Local preparations also exist and low dosages are less frowned upon – vaginal tablets, creams, rings and pessaries can be taken internally to supply oestrogen to the vaginal area only. Vaginal oestrogen has the advantage of being effective at lower doses and limiting your exposure to oestrogen because less reaches your bloodstream. It may also provide better direct relief of symptoms than oral oestrogen.
l Regular exercise is important as it keeps blood flow and genital circulation high.
l Experimenting with your diet can also be effective. Soy isoflavones (plant oestrogens), linseeds, fish oils, and black cohosh have been found to help.
BELIEVE IT….OR NOT?
Sexual activity has proven beneficial for postmenopausal women who have a substantially estrogenised vaginal epithelium. It has been shown to encourage vaginal elasticity and pliability, and the lubricative response to sexual stimulation. Women who participate in sexual activity report fewer symptoms of atrophic vaginitis and, on vaginal examination, have less evidence of stenosis and shrinkage in comparison with sexually inactive women.
* Dr Darren Green, a trusted figure in the field of media medicine, is a University of Stellenbosch graduate who adds innovative spark to health and wellness issues.
He features on 567CapeTalk, and is a regular guest on SABC3 and the Expresso show. Dr Green works as an emergency medical practitioner at a leading Cape Town hospital and completed four years of training as a registrar in the specialisation of neurology.
If you’ve got medical problems, contact the doctor at [email protected], 021 930 0655 or Twitter @drdarrengreen. Catch him in Cape Town on 567 CapeTalk, most Fridays at 1.30pm.
The advice in this column does not replace a consultation and clinical evaluation with a doctor. - Cape Argus