By Rebecca Bowers

EXECUTIVE SUMMARY

Data from a large longitudinal study indicate that more than 33% of women ages 57-69 report symptoms of vaginal dryness. However, research shows that more than 50% of women don’t report such conditions to their healthcare providers. Even fewer women take advantage of proven therapies such as vaginal estrogen tablets, creams, and rings.

  • During menopause, reduced estrogen levels can result in thinning of the vaginal epithelium. Women may experience itching, vaginal dryness, urinary symptoms, and painful intercourse.
  • To help healthcare providers and patients feel more comfortable discussing the physical changes that often can come with menopause, the North American Menopause Society and the International Society for the Study of Women’s Sexual Health created the term “genitourinary syndrome of menopause.”

Data from a large longitudinal study indicate that more than 33% of women ages 57-69 report symptoms of vaginal dryness.1 About half of women don’t talk to their providers about such conditions, and even less take advantage of proven therapies such as vaginal estrogen tablets, creams, and rings.

During menopause, reduced estrogen levels can result in thinning of the vaginal epithelium. Women may experience itching, vaginal dryness, urinary symptoms, and painful intercourse. Researchers for the current study analyzed data from more than 2,400 women who were enrolled in the Study of Women Across the Nation (SWAN) during a 17-year-period. At baseline, 19.4% of women ages 42-53 reported vaginal dryness; however, by the time they reached ages 57-69, 34% of them reported such symptoms.

Some women try lubricants as they begin to develop pain with sex, says JoAnn Pinkerton, MD, NCMP, executive director of the North American Menopause Society. However, if lubricants and vaginal moisturizers are not enough, other vaginal therapies are available, such as vaginal estrogen tablets, creams, a vaginal ring, and intravaginal dehydroandrosterone. In November 2016, the Food and Drug Administration approved Intrarosa (prasterone) to treat moderate to severe pain that some women experience during sexual intercourse as a result of menopause. The active ingredient prasterone is also known as dehydroepiandrosterone.

“It’s shocking that less than 4% of women in the SWAN study were using these effective therapies by the end of the study period,” observed Pinkerton in a press statement. “For women, please report symptoms, and for healthcare providers, please offer safe, effective therapies.”

Ask About Symptoms

In an earlier study, women 55 years of age and older from primary care offices and senior centers answered questions about common postmenopausal symptoms. According to the results, very common symptoms were itching, burning, stinging, pain, irritation, dryness, discharge, or odor. More than half of the respondents (51%) indicated they experienced one or more of the symptoms; 40% of those who experienced symptoms said they caused emotional problems, and 33% indicated the symptoms affected their lifestyle.2

It is no wonder women don’t discuss postmenopausal vaginal issues with their healthcare providers, says Susan Wysocki, WHNP-BC, FAANP, president and chief executive officer of iWomansHealth in Washington, DC, which focuses on information on women’s health issues for clinicians and consumers. First, women often take these issues as part of their normal lot in life, and second, they may not be in a sexual relationship at the moment, says Wysocki.

Clinicians should ask women in postmenopause if they have noted any vaginal changes, and complaints do not need to be related to current sexual activity, notes Wysocki. Providers should be aware of all measures to keep the vagina healthy well past menopause, and inform women about their choices, she states.

To help healthcare providers and patients feel more comfortable discussing the physical changes that often can come with menopause, the North American Menopause Society and the International Society for the Study of Women’s Sexual Health in 2014 created the term “genitourinary syndrome of menopause” (GSM).The term refers to “a collection of symptoms and signs associated with a decrease in estrogen and other sex steroids involving changes to the labia majora/minora, clitoris, vestibule/introitus, vagina, urethra and bladder.” These include symptoms of the genital area, such as dryness, burning, and irritation; sexual symptoms, such as pain, discomfort, impaired function, or lack of lubrication; and urinary symptoms, such as urgency, dysuria, and recurring urinary tract infections.3

How About Cancer Survivors?

Women who are survivors of breast cancer may experience more symptoms of GSM, with symptoms appearing earlier because of cancer treatments. Many such women have avoided using hormone treatments because data are lacking about the safety of vaginal hormone therapies and alternatives in women who have breast cancer or who have a high risk for the disease.

The North American Menopause Society and the International Society for the Study of Women’s Sexual Health have formed a consensus panel to determine clinical recommendations for those who work with this patient population.4

The guidance calls for providing individualized treatment for GSM that balances the risk of cancer recurring with the symptom severity and the effect they have on a woman’s quality of life. The recommendations provide guidance for decision-making about therapies when data from clinical trials are not available.

“Until additional studies are undertaken in this area, we are hopeful these consensus recommendations will provide added confidence for clinicians to move forward with treatment options that will provide relief to women from GSM symptoms,” said Pinkerton.

REFERENCES

  1. Waetjen LE, Crawford SL, Chang PY, et al. Factors associated with developing vaginal dryness symptoms in women transitioning through menopause: A longitudinal study. Menopause 2018; doi: 10.1097/GME.0000000000001130. [Epub ahead of print].
  2. Erekson EA, Li FY, Martin DK, Fried TR. Vulvovaginal symptoms prevalence in postmenopausal women and relationship to other menopausal symptoms and pelvic floor disorders. Menopause 2016;23:368-375.
  3. Portman DJ, Gass ML; Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: New terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and The North American Menopause Society. Menopause 2014;21:1063-1068.
  4. Faubion SS, Larkin LC, Stuenkel CA, et al. Management of genitourinary syndrome of menopause in women with or at high risk for breast cancer: Consensus recommendations from The North American Menopause Society and The International Society for the Study of Women’s Sexual Health. Menopause 2018;25:596-608.