Treatment Options for Vaginal Atrophy?
Although vaginal atrophy is considered a public health issue because it involves up to half the female population post menopause, many women have historically ignored symptoms or accepted their condition as a natural consequence of bodily ageing. This perception is changing for a number of reasons, largely because of easier access to information and treatment advice, coupled with the fact that most western women are living more than a third of their lives after menopause.
Today, more and more women are turning to medicine and innovative treatments to improve the tone, normal functioning and/or cosmetic appearance of their genital region; and many valuable treatment options are now available. The primary goal of vaginal atrophy treatment is to reduce symptoms and restore the normal physiological conditions of the vagina.
Don’t be afraid to ask your doctor, research on this website or feel free to submit a query to us or discuss your concerns with others in our Chatroom. There is now information and advice to guide you through the available treatment options that best meet your personal circumstances and preferences: Knowledge is Power!
Treatment options for vaginal atrophy will depend on severity and duration of symptoms, its impact on a woman’s quality of life and also on exogenous factors such as current medical condition and concurrent medical treatments. Not all treatments will be deemed effective and not all treatments will be equally suitable for all women.
The principal treatment options available to women today are explained below, including:
Non-prescriptions treatments for Vaginal Atrophy
Topical, non-hormonal lubricants and moisturisers are usually the first line of treatment for patients experiencing symptoms of vaginal atrophy. Lubricants relieve vaginal dryness during sexual activity but don’t provide a long term solution. Some of the available options include:
Such as Vagisil – this cream contains a local anaesthetic and can be used to attempt relief for itching and dryness. It is not recommended for use on a regular basis, however, as it may cause contact dermatitis of the vulva.
“Replens” is a non-hormonal gel, which aims to “plump up” the cells in the vagina. It is also low pH to help restore the normal acidic environment.
Lubricants such as KY Jelly can be water or oil-based and aim to overcome vaginal dryness by reducing friction, to help make intercourse more comfortable.
These are non-steroidal molecules of plant origin, which bind to oestrogen receptors. Common sources are soy or clover. Taken as food supplements, their absorption varies from person to person and, even in the same person, according to type of diet, interaction with antibiotics and the state of the gut flora. Hormonal interactions with these molecules are not limited to oestrogens, but concern also other hormones, such as androgens and thyroid hormones and so are not free from contraindications. There is also not enough clinical data that demonstrate their effectiveness and safety during menopause.
Prescription treatments for Vaginal Atrophy
Currently, the most-common treatment for vaginal atrophy requires the ongoing application of hormone replacement creams directly into the vagina. For a variety of reasons some women cannot use these creams, or they feel the application process is inconvenient and become irregular with and eventually discontinue use. Some of the available options include:
Topical Vaginal Oestrogen
Vaginal oestrogen in the form of a cream (eg. Ovestin) or pessary (eg. Vagifem). These topical oestrogens are delivered via an applicator and aim to increase levels of oestrogen to the vagina. It is generally only effective when a woman is using it regularly, as prescribed. However, once application is ceased, vaginal oestrogen decreases again and symptoms return.
Possible side effects include vaginal bleeding and unwanted breast pain. Although this type of oestrogen replacement does not directly enter a woman’s blood stream, it is still considered a hormonal treatment, which may not be suitable or safe for women following breast or ovarian cancer.
Hormone Replacement Therapy (HRT)
Hormone Replacement Therapy (HRT) is the medical replacement of the female hormones oestrogen, progesterone and sometimes testosterone. It comes in the form of tablets, patches, gels or implants. Symptoms of menopause, including vaginal atrophy, are helped and controlled effectively with HRT but the risk of systemic effects and longer-term sequelae can occur.
The current guideline in Australia is for a woman to take HRT at the lowest effective dose, for the shortest time period to alleviate symptoms, usually to a maximum of 5 years. More recent studies have, however, started to suggest the possible link between HRT use and increased risk of ovarian cancer, even with “short-term” HRT. Moreover, at least 10% of women may continue to experience menopausal symptoms, well into later life. This means patients are likely to have their symptoms return after cessation of HRT.
Women who cannot safely take HRT or who are at risk of adverse effects include:
- Women with breast cancer or current treatment for breast cancer
- Previous history of breast or endometrial cancer
- High risk of breast cancer including family history, BRCA-1 or 2 gene carriers
- Previous cardiovascular disease
- Previous venous thrombosis (clots in veins)
- Women considered to be at increased risk of cardiovascular disease or deep vein thrombosis
Tibolone (Livial) is a synthetic hormone, which acts like oestrogen, progesterone and testosterone. It aims to help improve vaginal dryness and discomfort by increasing vaginal secretions and also can help with increasing libido. However, at this stage, Tibolone has not been as extensively researched as other HRT treatments and is contraindicated in women who have had breast cancer.
Lasers are a relatively new treatment for vaginal atrophy. The fractionated and special thermic effect caused by a laser encourages renewed functional activity in the treated sections of tissue. They work by stimulating regeneration of the vaginal mucosa with new collagen fibre production, which thickens and strengthens the vaginal structure.
Currently, two laser therapies are available, CO2 and Er-YAG (Erbium). Both are proving to be safe alternatives to drug therapy and may provide greater all round relief from vaginal atrophy symptoms compared to HRT, with a longer period of symptom-free life after treatment.
Both laser procedures require no prior preparation by the patient as they are outpatient treatments needing no anaesthesia, with each session being relatively short (10 to 20 minutes).
Our experience with the fractionated CO2 laser for face, eye and neck rejuvenation has provided far better tightening and overall textural improvements compared to the Erbium laser (see Forum topic for “Why CO2 Laser”). At this stage, only the CO2 MonaLisa Touch laser has undergone extensive peer-reviewed clinical trials and patient studies and received US Food and Drug Administration (FDA) approval for the treatment of vaginal atrophy symptoms. We are finding exceptional results for nearly all patients with the MonaLisa Touch treatment but remain committed to listing all vaginal atrophy treatments on this site and encourage your feedback.