Understanding Postmenopausal Vaginal Atrophy: Conversation with Dr. Lauren Streicher
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Article By: Jody Smith
We're pleased to have the opportunity to interview Dr. Lauren Streicher. Dr.
Streicher is an Assistant Clinical Professor of Obstetrics and Gynecology at
Northwestern University's medical school, The Feinberg School of Medicine, in Chicago.
She's also a Diplomat of the American Board of Obstetrics and Gynecology, a Fellow in the American College of Obstetricians and Gynecologists. She belongs to the Association for Gynecologic Laparoscopy, the American Association of Gynecologic Laparoscopic Surgeons, and the North American Menopause Society.
Dr. Streicher is well-versed in minimally invasive surgery, laparoscopic hysterectomy and possible alternatives to hysterectomy. She has a particular interest and expertise in menopause and sexual health for aging women.
1. Most of us are familiar with the symptoms of menopause – hot flashes, night sweats – but women may not be as familiar with the symptoms of postmenopause. Can you discuss what changes are occurring in a woman’s body and the symptoms associated with postmenopause?
Menopause is experienced by all women as they age. It's a time of natural change in a woman’s life when her menstrual cycle ends, typically around age 51.
Women may experience and most are aware of symptoms such as hot flashes, insomnia, memory problems and irritability. What some women may not realize is that once the menopause transition is completed, they can still experience a variety of postmenopausal symptoms and their effects.
What happens in the body is that the ovaries produce less estrogen, a female hormone that can cause changes in the body. These changes typically start during and continue after menopause or “postmenopause”. Lower levels of estrogen experienced by postmenopausal women can cause atrophy of the vagina and lower urinary tract, called postmenopausal vaginal atrophy. Atrophy is the thinning of these tissues.
2. You mentioned postmenopausal vaginal atrophy. Can you specifically discuss this medical condition and its symptoms?
Women may not know the terms vaginal or urogenital atrophy, but chances are they are aware of or may be experiencing some of the symptoms. Symptoms of postmenopausal vaginal atrophy may include vaginal burning, itching and dryness, increased urgency in urination and painful sexual intercourse. These symptoms can impact relationships and intimacy with a spouse or partner. At least one-third of women experience some vaginal symptoms after menopause.
3. Why are some women hesitant to discuss these symptoms?
Perhaps it’s because women don’t often associate these symptoms with menopause. Compare this to the widespread societal awareness and discussion of men’s aging health issues. We as women need to start or increase our discussions of these problems to effectively manage them.
With the average age of menopause at 51 and women living into their 80s, they are living nearly one third of their lives in postmenopause. While some menopausal symptoms are more transient, such as hot flashes, night sweats and mood swings, there are other longer-lasting postmenopausal symptoms that many women are experiencing but fewer may have heard of.
Furthermore, many women don't have an understanding of just what is going on in their bodies causing their distressing symptoms. Some believe that the symptoms they’re experiencing are inevitable, irreversible and essentially an untreatable consequence of aging and menopause.
There has been a taboo against talking about such symptoms. As a doctor, I see this taboo on a regular basis, since I talk about such symptoms all day long.
Some women may feel uncomfortable or embarrassed at the thought of discussing their postmenopausal symptoms of vaginal atrophy. Others may not be connecting these symptoms with a treatable, medical condition.
However, I urge every woman to bring up their postmenopausal vaginal atrophy symptoms with their doctor to learn about the available prescription medications that are approved by the FDA to treat these symptoms.
4. Since many women do feel uncomfortable, what is the best time and best way to start the conversation with their health care provider? For example, do women need to wait for their annual exam to have this conversation?
Postmenopausal vaginal atrophy is a treatable, medical condition. Describing your symptoms in detail and sharing information about your lifestyle will allow you to take control of your health. It can help your doctor find a treatment that’s right for you. Your annual exam is a great time to discuss your symptoms, but you don’t have to wait until then. Talk with your doctor about the symptoms you're experiencing and ask about available treatment options.
Don't hesitate to bring up any medications that you may have heard about, and are wondering about. Even if your doctor isn't familiar with a specific medication many will make a point of learning about it, since it may indeed be helpful in managing your symptoms.
Here are a few ways to initiate the conversation:
I have some questions about symptoms that I have been experiencing lately.
I’ve been experiencing some vaginal discomfort (e.g., itching, burning, dryness) since menopause, and I’m wondering if there is anything I can do about it.
Since menopause, I’ve been experiencing the regular need to urinate and sometimes pain during urination. Is this normal?
I sometimes forget to take or apply medications as the doctor has told me. Is there a convenient treatment option I can try?
I learned about a product recently, and I’m wondering if it may help me?
Your doctor can tell you whether the symptoms you’re experiencing are related to postmenopausal vaginal atrophy.
5. What are available treatment options for postmenopausal vaginal atrophy?
There are a variety of FDA-approved treatments for postmenopausal vaginal atrophy. If you’re experiencing moderate to severe postmenopausal vaginal symptoms, including vaginal itching, burning and dryness, painful intercourse, urinary urgency or painful urination, one treatment option to discuss with your doctor is ESTRING ® (estradiol vaginal ring). It is important to work with your health care provider to find the treatment option that’s right for you.
6. You mentioned ESTRING ® (estradiol vaginal ring). What is it and how does it work?
ESTRING ® (estradiol vaginal ring) is used after menopause to treat moderate to severe vaginal itching, burning and dryness, painful intercourse, urinary urgency, and painful urination due to urogenital atrophy. It is an off-white, soft, flexible ring with a core that contains 2 mg of estradiol (an estrogen hormone).
ESTRING ® (estradiol vaginal ring) is a form of estrogen, which works like your body’s natural estrogen to treat these local symptoms. Once inserted, ESTRING ® (estradiol vaginal ring) works to help relieve these symptoms by releasing a steady, low-dose of estradiol for a 90-day treatment period.
ESTRING ® (estradiol vaginal ring) is inserted once for a 90-day treatment period and removed after 90 days. So after you insert one, you do not have to remember to insert it every day.
Estrogens increase the risk of cancer of the uterus and should be used only as long as needed. Common side effects include headaches, increased vaginal secretions, vaginal discomfort, abdominal pain, and genital itching. You and your health care provider should talk regularly (such as every 3 to 6 months) about continued use of estrogen-containing products like ESTRING ® (estradiol vaginal ring). Additional Important Safety Information is available at the end of the article.
You should discuss the potential benefits and risks of ESTRING ® (estradiol vaginal ring) with your health care provider. Do not use ESTRING ® (estradiol vaginal ring) if you have unusual vaginal bleeding, have or have had cancer of the breast or uterus, had a stroke or heart attack, have or have had blood clots or liver problems, are allergic to any of its ingredients, or think you may be pregnant. Additional Important Safety Information is available at the end of the article.
All medications have benefits and risks. It is important to talk with your doctor about the best treatment for you. Go to www.ESTRING.com to learn more.
7. Why do you recommend ESTRING ® (estradiol vaginal ring) to your patients?
In my experience, ESTRING ® (estradiol vaginal ring) effectively treats moderate to severe symptoms of postmenopausal vaginal atrophy. My patients report that the ring is both convenient and comfortable. Like any prescription medication, it’s important that you talk to your doctor to find out what’s right for you.
Estrogens should be used only as long as needed because they increase the risk of cancer of the uterus. If you experience any unusual bleeding, call your doctor right away. You and your health care provider should talk regularly (every 3 to 6 months) about continued use of estrogen-containing products like ESTRING ® (estradiol vaginal ring). Additional Important Safety Information is available at the end of the article.
8. Do you have any advice for women who may be struggling with the symptoms of postmenopausal vaginal atrophy and are seeking the right treatment option?
Postmenopausal vaginal atrophy is a treatable, medical condition. Information is available to help you. A good resource for women is the North American Menopause Society (NAMS) for information and to find a recommended expert in your area. Check out their website at http://www.menopause.org/.
Don’t delay – have a conversation with your doctor about your postmenopausal vaginal symptoms and ask if ESTRING® (estradiol vaginal ring) is the right treatment option for you. Visit www.Estring.com for more information.
ESTRING ®® (estradiol vaginal ring) is used after menopause to treat moderate to severe vaginal itching, burning and dryness, painful intercourse, urinary urgency, and painful urination due to urogenital atrophy.
IMPORTANT SAFETY INFORMATION
Estrogens increase the risk of cancer of the uterus. It is important that you report any unusual vaginal bleeding to your healthcare provider right away.
Do not use estrogens with or without progestins to prevent heart disease, heart attacks, strokes, or dementia.
Using estrogens with or without progestins may increase your risk of heart attack, stroke, breast cancer or blood clots. Using estrogens with or without progestins may increase your risk of dementia, based on a study of women age 65 years or older.
Estrogens should only be used for as long as needed. You and your healthcare provider should talk regularly about whether you still need treatment with ESTRING ® (estradiol vaginal ring).
ESTRING ® (estradiol vaginal ring) should be removed after 90 days of continued use.
Do not use ESTRING ® (estradiol vaginal ring) if you have unusual vaginal bleeding, have or have had cancer of the breast or uterus, had a stroke or heart attack, have or have had blood clots or liver problems, are allergic to any of its ingredients, or think you may be pregnant.
The most frequently reported side effects are headaches, increased vaginal secretions, vaginal discomfort, abdominal pain, and genital itching.
Call your health care provider right away if you have any of the following warning signs: breast lumps, unusual vaginal bleeding, dizziness and faintness, changes in speech, severe headaches, chest pain, shortness of breath, pain in your legs, or changes in vision.
Carefully follow instructions for use. If you have difficulty removing ESTRING ® (estradiol vaginal ring), contact your healthcare provider right away.
Call your doctor for medical advice about side effects. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1‐800‐FDA‐1088.