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Your Health
During Menopause

What Is Menopause?
What IS A Hot Flash?
34 Signs of Menopause
Meno Survival Tips
Bioidentical Hormones
Revival Soy Protein
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The HRT Controversy
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'For natural, bioidentical hormones, Pete Hueseman and Bellevue Pharmacy Solutions

Why put your body through the rigors of adjusting to the "one-size-fits-all" HRT when naturally compounded, bioidentical hormones can be tailor-made to your body's needs?

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Atrophic Vaginitis, Sexuality And Menopause

One of women's strongest menopause-related complaints is dyspareunia. But, unless you make a point of asking, you may never find out about it. Estrogen deficiency causes the vaginal membranes to become dry, friable, thinner, and therefore more easily irritate. Effects may include itching, burning, and pain on and after penetration.

Topical strategies Any medication that causes drying of the mucous membranes can exacerbate the problem. Determine whether the patient is taking antihistamines, decongestants, or any other drug with drying potential. If possible, substitute something else or lower the dosage. Suggest a perineal wash once a day. Instruct the patient to sit well back on the toilet and rinse the vulvar region with a quart of plain water. Opening the labia gently with one hand, she should spray the water from a squirt bottle or pour it slowly from one corner of a square or rectangular container.

A naturopathic agent known as tri-estrogen cream or triple estrogen cream is available from selected pharmacies, such as those specializing in holistic or women's health (see "Pharmacies that sell - and ship - natural hormone products"). Estrogens are extracted from natural sources like soy and yams and blended in a ratio of 80% estriol, 10% estradiol, and 10% estrone. Tell patients that the product does not provide protection against heart disease or osteoporosis.

Applying vitamin E oil helps to hydrate the vaginal membranes. Creams or ointments from calendula (Calendula officinalis), comfrey (Symphytum officinale), or St. John's Wort (Hypericum perforatum) may decrease the vulvar or vaginal burning, itching, and other symptoms of dryness that result over time from thinning of the external skin. These products are generally applied externally once or twice a week or as needed.

A more traditional route is the use of any of a number of estrogen vaginal creams (see "Nonsystemic Estrogens,"). OTC water-based vaginal lubricants, such as K-Y Jelly, are also available. One OTC product, Replens Vaginal Moisturizer, hydrates vaginal tissue for 2-3 days after a single application. Caution patients that petroleum-based products such as petrolatum or petroleum jelly can break down latex condoms, foster infections, and form a barrier against natural lubricants. Naturopathic vaginal lubricants include olive oil, wheat germ oil, sesam oil. A square quilted cotton makeup pad is soaked in any of these oils, squeezed out, and inserted in the vagina overnight once a week or as needed. Narrowing of the introitus can induce dyspareunia in women who have intercourse infrequently.

Suggest to such patients that they insert a couple of fingers in the vagina during a bath or shower and gently stretch the tissues. Doing so may prevent vaginismus and pain on penetration.

Regular sexual activity, including masturbation, also helps to retain normal function.

Women can reduce the pain of penile thrusting by seeking sexual positions that give them more control. They can also encourage their partners to prolong foreplay to aid vaginal lubrication, which typically becomes delayed with age. The use of graded vaginal dilators may be used to prepare women to resume intercourse comfortably after a long period of abstinence.

Vaginal itching may be eased with an oatmeal bath. Cooked oatmeal can be placed in a strainer and held under the tap as the tub Ms. An OTC bath product - natural colloidal oatmeal - is also available and may prove more convenient.

Oral agents Ingesting yogurt products that have a high acidophilus count helps to maintain vaginal pH as the vaginal flora become altered with age. Acidophilus, which requires refrigeration, is also available in capsule form - 460 mg/d supplies the amount of acidophilus in 8 cups of yogurt. While the capsules are usually swallowed, they can also be inserted vaginally, especially for vaginal infections.

Chasteberry (Vitex), taken in a tea, is said to revitalize vaginal tissue. Oral administration of dong quai, an estrogen precursor, has been reputed to enhance lubrication and relieve other menopausal symptoms. However, results from a recent study indicate that dong quai has no estrogenic effect on endometrial thickness or vaginal cells in postmenopausal women, and it's no more useful than placebo in relieving menopausal Symptoms.14

Zinc, at a dosage of 15 mg/d, is thought to revive vaginal tissue as well - wheat germ, seafood, meat, and oats are all good food sources. Evening primrose oil, a common folk treatment for symptoms of premenstrual syndrome, is said to have hormone-mediating properties. These are attributed to (Gamma)-linolenic acid, the essential ingredient. Licorice root, an estrogen precursor, and sarsaparilla, a progesterone precursor, are often used in combination for flushing. Large doses of licorice root - also known as glycyrrhiza - can on rare occasions increase blood pressure, so women with hypertension should avoid using the agent.

Since decreased sexual desire tends to be of multifactorial origin, medication may not be the answer. Stress, fatigue, body image, and relationship difficulties typically play a part. Many drugs, including antidepressants, can inhibit libido. Reassure your patient that her capacity to achieve orgasm will remain physiologically unimpaired. A low-dose (2%) methyltestosterone cream applied nightly or bid over the clitoris may improve the situation without inducing masculinizing - though reversible - side effects such as facial hirsutism and deepened voice. This product must be specially compounded by a willing pharmacist.

Many women take the much-touted dehydroepiandrosterone (DHEA) to heighten libido. Because long-term safety and efficacy are unknown and hepatic and lipoprotein-related effects are suspected, one should take no more 50 mg. of DHEA a day. Also, liver function tests and lipoprotein profiles and serum testosterone should be checked regularly.

Additional reading: Sexuality at Midlife and Vaginal Health.

An excellent transcript by transcript by Gynecologist and Vulvovaginal health expert, Elizabeth Stewart, M.D.





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