By Erin Conlon, ND, MS

As we go through life we experience various and sundry joys of fluctuating hormones.  For many women, teen years bring forth a roller coaster of emotions and physical changes as we experience new and evolving levels of hormones.  The modification of hormones in pregnancy can further alter bodies and impact emotions.  Finally, the culminating change in hormones, known as menopause, influences the body in entirely new ways, as hormone production declines.

The menopausal change in hormone levels may present with an assortment of symptoms that includes flushing with waves of internally generated heat, mood lability, vaginal dryness, and mental cloudiness.  Symptoms of hot flashes, mood swings, and brain fog often bring a woman into her doctor’s office, as these are commonly discussed topics.  But all too often, symptoms of vaginal dryness or pain with vaginal penetration are left untreated due to associated social stigmatization.  It should be noted that roughly 50% of postmenopausal women experience vaginal dryness between the ages of 50 and 70, a number that increases to over 70% after age of 70.  Unfortunately, only about 25% of affected women seek medical treatment for this condition.

Vaginal dryness is often accompanied by sensations of itching and burning, increased incidence of urinary tract and vaginal infections, and urinary leakage.  Furthermore, vaginal dryness can contribute to pain with penetrative vaginal activity and an associated decreased libido.  This constellation of symptoms may all be attributed to a condition call atrophic vaginitis.  This atrophy/thinning, also affects a decline in pelvic floor/vaginal tone, urinary incontinence, and changes in the vaginal and bladder ecology such that vaginal and bladder infections can become more common.

Atrophic vaginitis is the change in vaginal tissue and lower urinary tract following the loss of estrogen, which may occur with natural, surgical, or chemical menopause.  Current standard-of-care treatment for atrophic vaginitis is local vaginal estrogen.  The hormone can be delivered to the vagina through a variety of methods, including creams, suppositories, vaginal tablets or ring.  Creams, tablets and suppositories are generally used nightly for two weeks and then twice a week thereafter. Rings are used continuously.  The purpose of this long-term therapy is to help preserve the ecology, pH, and tissue of the vagina.  While the majority of the hormone is delivered directly to the vaginal tissue, some studies have shown that vaginal estrogen may contribute to elevations in systemic estrogen.  The potential for vaginal estrogen therapy to alter body-wide hormone levels, albeit very minimally, makes the treatment less than ideal for some women.

Fortunately, there are other options to treat atrophic vaginitis!  DHEA, also known as dehydroepiandrosterone, is a precursor hormone that when in the presence of necessary enzymes, can be converted to testosterone and eventually estrogen.  In November 2016, the U.S. Food and Drug Administration approved DHEA to be used vaginally to treat atrophic vaginitis and associated symptoms.  Research regarding DHEA has demonstrated the ability for the compound to improve symptoms of vaginal dryness and pain with sexual activity.  In the future we may find that DHEA improves libido.  Presently, however, data are limited and more research is needed to truly elucidate the impact of DHEA on libido.  Additionally, daily use of DHEA appears to keep systemic hormones within the same ranges demonstrated in menopausal women not using hormone therapy.  However, small increases in systemic estrogen have been noted with daily DHEA use, thereby potentially ruling it out as a treatment option in certain populations of women.  Finally, it is of note that DHEA must be used daily in order to remain effective.

Discussed here are just two potential treatment options for atrophic vaginitis.  Primary care doctors and women’s health providers have a variety of treatment options for this condition.  Talk to your doctor about any menopause associated vaginal symptoms that you may be experiencing so you can get a tailored treatment that is best for you!