Treatment of vulvovaginal atrophy (VVA) in postmenopausal women should start as early as possible and continue as long as required, researchers say. It is important that they encourage women to report their VVA symptoms early to their healthcare professionals. This must not regarded by the healthcare profession, society and the media as a taboo subject. It is (also) important that healthcare professionals engage their menopause patients in conversations regarding VVA in a professional and sensitive manner.
“If they do not ask the correct questions, the information may not volunteered by the patient.” If therapy is delayed for too long; VVA changes can become less reversible or irreversible, regardless of the type of therapy used. As reported online March 18 in Maturitas, baseline symptoms for both groups included vaginal dryness inside and outside; pain inside; pain during intercourse and exercise; bleeding during intercourse or sexual contact; and burning, itching or irritation.
The non-hormonal therapy
About 37% of women in both groups had urinary incontinence. The most common treatment was non-hormonal therapy applied vaginally (31.8%), followed by hormonal therapy applied vaginally (11.6%); and systemic hormonal therapy (4.7%). Women on VVA treatment presented with more and worse symptoms. The authors suggest, “The most plausible interpretation might that women only seek or commence treatment when symptoms have already become so distressing they cannot tolerate them any longer.”
Compared with untreated women; sexual function was higher in those who treated (FSFI: 16.7 vs 15.6), as was the sexual distress score (FSDS-R: 12.3 vs 9.2). Similarly, the DIVA score was significantly worse overall for treated versus untreated women in three of the four dimensions: emotional well-being, sexual functioning, and self-concept and body image. Women treated with systemic hormones had fewer VVA symptoms, lower vaginal impact (DIVA), and better sexual function (FSFI and FSDS-R) and vaginal health.
The menopause transition
Treatment duration had no impact on the findings. It is likely that the women on systemic therapy had less severe symptoms because (therapy) had initiated early in the menopause transition to treat hot flushes and sweats before VVA symptoms had become severe. Whether the therapy is local or systemic; the key point is that it should start early in order to be most effective and avoid needless suffering.
“Women experiencing VVA often agonize in silence for many years,” she told Reuters Health by email. “Hot flashes may improve over time, but VVA only worsens with time. With menopause and the loss of estrogen stimulation in the vagina, the tissue becomes dry and pale. “The labia can become fused and the vagina and clitoris shrink. As a result, intercourse and other forms of vaginal contact become painful, if not impossible.”
“The doctor must guide the patient,” she said. “I tell my patients the bottom line is that quality of life, especially in the bedroom, is incredibly important and should a priority. Expect the unexpected as your vulva and vagina transition from peri-menopause to menopause. Communicate openly with your partner so they know what you are going through. The aging vagina does not have to ruin a sexual relationship.