TREATMENT FOR UROGENITAL SYMPTOMS

Many women experience vaginal dryness, painful intercourse, urinary urgency, urinary frequency and urinary incontinence. Collectively these symptoms are referred to as urogenital symptoms or the Genitourinary Syndrome of Menopause.

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These symptoms occur due to lower levels of estrogen and decreased blood supply to the vulvovaginal area. The vaginal and bladder tissues become thin and easily irritated. This is referred to as vaginal atrophy.

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There are several options to treat these symptoms. There are over the counter products, prescription medications and mechanical treatment options.

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Over the counter products include moisturizers and lubricants. Moisturizers are vaginal cream/gels that are used as needed for comfort and are not related to sexual activity. Lubricant are vaginal gels that are used with sexual activity.

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The prescription medications include vaginal estrogen tablets, vaginal estrogen creams, vaginal estrogen rings, vaginal DHEA creams and oral SERM (selective estrogen receptor modulator) tablets.

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The symptoms are often greatly improved after 6 weeks of using one of these medications. You need to continue to use the medication to prevent the recurrence of the symptoms. Using a vaginal estrogen or DHEA is not hormone replacement therapy as the dose of medication used is very small and only small amounts get into the bloodstream. It would not help with other symptoms like hot flashes but also has fewer risk than whole-body hormone replacement therapy.

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Mechanical options increase blood supply to the vulvovaginal tissue. Sexual activity (with or without a partner) helps maintain healthy vaginal tissue and decreases vaginal dryness. Vaginal dilators and pelvic floor physical therapy can also be helpful for some women. There are also various vaginal laser procedures that are undergoing evaluation currently for treatment of vaginal atrophy. These may be particularly useful for women who cannot use the vaginal estrogens or DHEA, such as women with breast cancer.

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Some urinary symptoms, such as urinary incontinence, may need to be evaluated by a urologist.