DEAR DOCTOR K: I’ve been bothered by vaginal dryness. Sex is painful. My doctor believes it’s vaginal atrophy due to menopause. Can you tell me more about this condition? How is it treated?
DEAR READER: During a woman’s reproductive years, the lining of the vagina is kept moist and lubricated in part by female hormones made by the ovaries — particularly estrogen. With the start of menopause, estrogen levels decline. This often leads to vaginal atrophy: The lining of the vagina becomes thin and dry.
Natural menopause is not the only reason for estrogen levels to drop and vaginal atrophy to develop. Breastfeeding, surgical removal of the ovaries and certain medical treatments can also do it.
As you’ve experienced, the reduced lubrication of the vagina can lead to painful sexual intercourse. It can also cause vaginal itching or burning. You may experience light bleeding after sex. Such light vaginal bleeding following sex is not a worry, as long as it does not also occur at times unrelated to sex.
Vaginal atrophy is best treated with estrogen therapy. This is available in many forms. Some forms apply estrogen directly to the lining of the vagina. For example, estrogen creams or suppositories are inserted into the vagina using an applicator. A vaginal ring can be placed in the vagina for three months. It slowly releases estrogen directly to the vaginal tissues.
Vaginal estrogen preparations produce very low levels of estrogen in the blood. They are the safest way to treat vaginal atrophy with estrogen. But some of my patients do not like applying creams or placing devices in the vagina, and prefer something easier.
One alternative some women prefer is an estrogen pill. Another treatment is an estrogen patch that is applied to the skin once or twice a week. The pill and the patch deliver estrogen into the blood. When the blood reaches the lining of the vagina, the estrogen in the blood causes the lining to become thicker and more moist.
As you’re likely aware, studies have found that estrogen therapy given in pill form may slightly increase the risk of having a stroke. This is particularly true if the estrogen pill also contains progestin sex hormones, the usual form of hormone therapy. However, doctors still recommend short-term estrogen pill therapy to treat temporary symptoms of menopause. Your doctor will use the lowest dose possible to relieve your symptoms. In my experience, the lowest dose (typically half of the usual dose) is often very effective, and less likely to cause side effects.
You may prefer to avoid estrogen altogether. If so, try a water-soluble lubricant. Lubricants relieve vaginal dryness, moisten vaginal tissues and can help make sex less painful. They can be purchased without a prescription at most pharmacies or grocery stores.
Regular sexual activity also can help to prevent symptoms. This is because sexual intercourse improves blood circulation to the vagina. This helps to keep vaginal tissues healthy.
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)