Read Dr. Williams article in Health + Fitness

Posted on April 20th, 2015

Suffering in Silence No Longer—A Breakthrough in the Treatment of Menopausal Vaginal Atrophy

Every year, millions of women enter menopause.  For some, this can be a happy occasion that heralds the end of worrying about periods and birth control.  But for many women, this marks the onset of disturbing symptoms that may include hot flashes, night sweats, insomnia, and mood swings.

Yet for at least half of these women some of the most distressing symptoms happen to be the least talked about.  These are the symptoms of vulvvaginal atrophy (VVA).  The most common manifestations include painful intercourse, vaginal dryness, itching and irritation, and painful or frequent urination.  Nevertheless, only half will seek medical attention or even mention these symptoms to their doctors.

Vulvovaginal atrophy results from the chronic lack of estrogen production that occurs naturally in the menopause.  This in turn leads to thinning of the vagina and surrounding tissues, reduced moisture, narrowing of the vagina, and constriction of the vaginal opening.  These “normal” physiologic changes may explain why using over-the-counter lubricants alone may not be sufficient to alleviate painful intercourse. 

For decades the gold standard of treatment for VVA has been vaginal estrogen which, when used correctly, has been proven an effective treatment. Yet compliance is quite poor due to its inconvenient dosing and the need for indefinite usage.  At the same time many women have concerns about prolonged exposure to hormones.  Likewise, the use of vaginal estrogens is commonly advised against for women with a history of estrogen-dependent malignancies such as breast cancer and uterine cancer.  There is also more recently available a prescription daily oral tablet, ospemifene (brand name Osphena), which also appears to be effective but is once again contraindicated in women with a history of estrogen-dependent cancer and cautioned against in those who are at high risk for blood clot, heart attack, or stroke.

Fortunately for most women experiencing any or all symptoms of VVA, there is now available vaginal laser therapy.  Consisting of three quick, relatively painless laser treatments performed 4-6 weeks apart, the MonaLisa Touch™ laser system stimulates the production of collagen in the vaginal and surrounding tissues thereby improving elasticity, blood flow and moisture.  This FDA approved device was developed in Italy and to date, more than 5000 women worldwide have undergone this procedure.  Early studies as well as ongoing research have demonstrated that after the full course of three laser therapy sessions, a majority of those women experienced remarkable improvements in painful intercourse as well as significant reductions in vaginal burning, itching, dryness, and urinary complaints. 

The distinct advantages of the MonaLisa Touch™ are that it occurs in an office setting, requires no anesthesia, has virtually no adverse events, and may induce some improvement as early as one week after the 1st procedure.  Maximum benefit however will not be achieved until after the third treatment.  The primary drawbacks are cost, in that it is not yet covered by insurance, and yearly “touch-up” treatments may be required. 

Women with menopause-related vulvovaginal atrophy should never be resigned to just tolerating it.  Unlike other menopause symptoms that may improve over time, VVA symptoms may actually worsen with age.  Considering that most women will spend over thirty years of their lives in menopause, their healthcare providers need to be more proactive about addressing these issues with them.  But armed with the knowledge that one no longer needs to suffer in silence, hopefully women can in turn approach their physicians with more openness and less embarrassment.


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