Vaginal Dryness

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• 0:03Introduction
• 0:25Urinary symptoms
• 1:32Vaginal estrogen
• 3:48Moisturizers and lubricants
• 4:56Laser treatment

Full transcript

1. 0:03Introduction

   Hi, I'm Dr. Taz Varkey. Welcome back to GynoTalks. Today I'm gonna do part three of my menopause series, and I want to focus in on one particular symptom of menopause that plagues many menopausal women, and that is vaginal dryness. So we actually call this part of menopause genitourinary syndrome of menopause. It's been renamed because it includes not just vaginal dryness but urinary symptoms such as urinary frequency, maybe feeling irritated in the area of the bladder.

2. 0:25Urinary symptoms

   So women often think they have UTIs, or urinary tract infections, and they go into their doctor and they get the urine test and there's no bacteria, no sign of an infection, but they just always feel uncomfortable.

3. 0:48

   Another urinary symptom is a little bit of incontinence, which means a little urine loss. And this can all happen, including vaginal dryness of course, because we're losing estrogen in the vaginal pelvic area, and that causes a weakening of the tissue in the vagina, and the vagina supports the urethra and the bladder above it, right?

4. 1:09

   So all of these tissues lose strength and elasticity, and therefore they feel dry to patients. And the most common time patients experience vaginal dryness is during sex. It can feel sandpapery and rough and maybe even hurt, and then that in turn affects your libido and your relationship. So this could be a real significant problem for women, and it's not addressed very well in our routine visits.

5. 1:32Vaginal estrogen

   So what can we do about vaginal dryness if you're experiencing this during perimenopause, menopause? Well, the most effective treatment, or what we say the first-line treatment, is vaginal estrogen, and this comes in different forms. There is a vaginal ring that can be left in place for a few months at a time.

6. 1:55

   There are creams that can be inserted into the vagina a couple times a week. There are little tablets that can be pushed in. There's many different forms of vaginal estrogen, but they all treat locally, especially the tablets that go in. There's one that's an estrogen tablet, ten micrograms, even available now, very recently, in a four microgram dose, even lower.

7. 2:17

   And these are put into the vagina for the first two weeks. We have you do it every night, and then it's just two or three times a week. And when we measure women's serum estrogen levels after they've inserted these vaginal estrogens, we find a very slight change in their estrogen levels.

8. 2:39

   So it doesn't seem to change our estrogen content around our body to any significant degree. And for that reason most gynecologists do not give progesterone to their patients if they're treating them only with vaginal estrogen. And why would progesterone be important?

9. 3:02

   Well, if we're giving oral estrogens, as I discussed in a prior video, or a systemic estrogen through the skin or orally, we have to give progesterone to protect the uterus from uterine cancer. But when we're giving estrogen vaginally, it's so minimally absorbed that it's not routine practice to give progesterone. And we thus far, after having done this for decades, have not observed an increased risk of uterine cancer in women who are usually using vaginal estrogens at the recommended doses, even if they're not on progesterone.

10. 3:25

    So if you use that vaginal estrogen regularly, most often you'll notice at least an improvement in your vaginal dryness and maybe even in some of those urinary symptoms of the nighttime urinary frequency or incontinence.

11. 3:48Moisturizers and lubricants

    But maybe you don't want to take vaginal estrogen, or you can't because of other medical problems. What other options are there? You can try vaginal moisturizers. Now most patients don't know much about these. They know about vaginal lubricants, and vaginal lubricants are basically water-based lubricants that the man can place on his penis or a woman can even insert into the vagina at the time of sex to make it smoother and less rough or sandpaper, as I mentioned before.

12. 4:11

    But vaginal moisturizers are something that women can use more regularly, just like you moisturize your skin with lotion after a shower. You can insert vaginal moisturizers three times a week, just as a maintenance, and also use lubricants at the time of sex.

13. 4:35

    And those two things in combination have been shown to be better than using nothing at all. They haven't been shown in studies to be as good as using vaginal estrogen, but there's a much improvement for patients who use vaginal moisturizers as opposed to women who are just given placebos or use nothing.

14. 4:56Laser treatment

    So lastly, we also have new treatments that include CO2 fractional laser treatments in the vagina, and they come under many different names because many different companies are making these laser machines. And we've used this laser technology elsewhere in the body, but it's only been in the last few years that we've started using them in the United States for the alleviation of vaginal dryness or urinary symptoms.

15. 5:18

    It should be mentioned here that this is not an FDA approved indication. So in other words, this machine has been used, as I said, elsewhere, but the FDA hasn't approved use of this CO2 fractional laser for the purpose of improving vaginal dryness.

16. 5:41

    And that's important because if the FDA hasn't approved it, then we can't say for sure that it works or what there aren't any other long-term side effects. That being said, many gynecologists including myself have used the laser on patients who don't want to use vaginal estrogen or for whom it's not working, and I have seen a benefit, as have my colleagues, and many patients have come back saying that they've noticed a good improvement.

17. 6:04

    So for some patients it really does seem to work. So that's it on this topic. I hope this was helpful. There's more you can learn if you want to come in to me and you're my patient, and I'm sure your doctor you can share more with you. Thank you for tuning in, and don't forget to subscribe.