Dear Readers,

Mrs M.V. is a 54-year-old married woman who resides in Old Harbour. She experienced her 'change of life' several years ago at 49 and coped quite well with it, as she didn't seem to experience as many of the hot flashes as some of her female friends.

However, more recently, she has noticed a new dryness in her vagina which, for the first time, is causing some problems during sex. She feels that she is not producing enough secretions to properly lubricate her vagina so sexual intercourse is now sometimes an uncomfortable experience.

She finds this embarrassing and has not said anything much to her partner about it although he has noted some changes. She finds this new complication depressing and admits that it is affecting her self-confidence and makes her feel less attractive to her gentleman. She visited her doctor who confirmed that the vaginal dryness was due to her change of life. The doctor wanted to prescribe hormonal pills but M.V. is unwilling to take them because she has heard that they have side effects. M.V. asks Lifeline if there is any alternative treatment.

Vaginal infections

Dryness in the vagina at menopause is often due to ATROPHIC VAGINITIS. As the oestrogen levels decrease after menopause, the vaginal walls become drier and less elastic. There is less vaginal lubrication and the entire vaginal canal shrinks (or atrophies). This problem results in vaginal burning and itching, which often result in painful sexual intercourse. Also, as the vaginal tissues dry out and become thinner they are more easily injured during sex and are more prone to vaginal infections.

Hormone replacement therapy (HRT) is the most regularly prescribed treatment for relieving menopausal (change of life) symptoms. HRT not only reduces the occurrence of hot flashes but also reduces the risk of heart disease and hip fractures due to osteoporosis. Use of HRT also relieves vaginal dryness, wrinkles and other signs of ageing, insomnia, depressive symptoms and the loss of energy, which can also be associated with the menopause. HRT works very well towards reducing menopausal symptoms. However, some women are advised against using HRT, for example, those with a history of cancer, liver disease or clotting disorders. Women who smoke should not use it either. Also, HRT is always prescribed with caution, as there is documented evidence of a small but still significant risk of increase in oestrogen-dependent breast cancer and endometrial cancer.

The problems associated with atrophic vaginitis can be helped with the local application of oestrogen creams to the vaginal walls. The insertion of oestrogen cream to the vagina is used for only a few days each month and restores the acidic balance to the vagina, which also results in a reduction of vaginal infections. This is one form of more localised (but still hormonal) treatment for 'dry vagina' due to menopause, which eliminates long-term daily oral HRT.

Evening Primrose

The ingestion of plant oestrogens (phytoestrogen) is well established as one method of reducing some of the symptoms associated with menopause. A common preparation is evening primrose. Soy products are well known to increase cell growth in the vaginal wall and increase levels of high-density lipoprotein (good cholesterol), which helps reduce the risk of heart disease. Eating just two ounces of soy products is thought to be enough to reduce menopausal symptoms as well as to reduce the risk of cancer and heart disease.

Other foods which contain phytoestrogens are apples, cabbage, oats, olives, olive oil, pawpaw, pumpkin, kidney beans, sunflower seeds, split peas and yams.

Black cohash is a herbal preparation which enhances the production of oestrogen and helps diminish hot flashes. Camomile, passion flower and valerian help to relax the nerves and induce sleep when insomnia is a problem. The Chinese product, dong quai, is also useful in reducing menopausal symptoms.

Exercise

Finally, exercise is very important for the menopausal woman as it builds energy levels and helps with a positive attitude. Exercise also helps to prevent osteoporosis and heart disease. Menopause is a natural part of a woman's life cycle. At this time, medically, it cannot be prevented as it is important for peri- and postmenopausal women to have an understanding of the changes which may occur to their bodies at this time and it is important for them to seek help with complications which may occur during this transition period so that the experience is problem free and uncomplicated.

Atrophic vaginitis is certainly treatable and is, therefore, unnecessary to experience.

Write to:

Lifeline

PO Box 1731

Kgn 8

A.J.M.