Vaginal atrophy

Diagnosis

Diagnosis of GSM may involve:

• Pelvic exam. A test where your doctor touches your pelvic organs and visually inspects the vagina, cervix, and external genitalia.
• Urine test. If you experience urinary symptoms, this includes collecting and testing your urine.
• Acid balance test, involves drawing vaginal secretions for testing or inserting a paper indicator strip to check the vagina’s acid balance.

Treatment

Your doctor could first suggest over-the-counter remedies for genitourinary syndrome of menopause, such as:

• Vaginal moisturizers. To replenish some moisture in your vaginal area, try using a vaginal moisturizer. The moisturizer might need to be used every few days. In general, a moisturizer’s benefits linger a little longer than a lubricant’s.
• Water-based lubricants. When used right before sexual activity, these lubricants help lessen discomfort. Glycerin and warming characteristics may irritate women who are sensitive to them, so choose products that don’t include any of these ingredients. If you’re using condoms as well, avoid petroleum jelly and other lubricants made of petroleum because they may cause latex condoms to rupture.

If none of those remedies help to reduce your symptoms, your doctor might suggest:

Topical estrogen

Because less vaginal estrogen enters your circulation, it offers the advantage of being effective at lower levels and reducing your overall exposure to estrogen. Additionally, it might offer more effective immediate symptom relief than oral estrogen does.

Various methods of vaginal estrogen treatment exist. You can select which one is ideal for you with the help of your doctor because they all appear to function equally well.

• Vaginal estrogen cream. Typically at night, you apply this lotion with an applicator directly into your vagina. However, your doctor will advise you on how much cream to use and how frequently to insert it. Typically, women use it daily for one to three weeks and then once to three times a week after that.
• Vaginal estrogen suppositories. These are low dose estrogen suppositories which will that will be used daily for weeks by insertion into the vagina as a depth of 2 inches. After that, they will need to be used only twice a week.
• Vaginal estrogen ring. A soft, flexible ring is inserted into the upper vagina by you or your doctor. The ring must be changed about every three months and continuously releases estrogen while it is in place. A ring with a larger dose is regarded as a systemic as opposed to a topical treatment.
• Vaginal estrogen tablet. You insert a vaginal estrogen tablet using a disposable applicator. You’ll be told by your doctor how frequently to insert the medication. For instance, you might use it twice a week after using it everyday for the first two weeks.

Ospemifene

When used daily, this medication can assist women with moderate to severe GSM manage their uncomfortable sex sensations. It is not recommended for use in women who have had breast cancer or who are at high risk of getting it.

Prasterone

These vaginal inserts directly transfer the hormone DHEA to the vagina to lessen the discomfort of intercourse. DHEA is a hormone that aids in the production of estrogen and other hormones by the body. For moderate to severe vaginal atrophy, prasterone is administered every night.

Systemic estrogen therapy

Your doctor can advise estrogen pills, patches, gel, or a higher dose estrogen ring if vaginal dryness coexists with other menopause symptoms including moderate or severe hot flashes. When consumed orally, estrogen reaches the entire body. Inquire with your doctor about the advantages and disadvantages of taking oral estrogen, as well as whether or not you would also need to take a hormone called progestin at the same time.

Vaginal dilators

Vaginal dilators are a nonhormonal therapy alternative that you may employ. In addition to estrogen therapy, vaginal dilators may be employed. To stop the vagina from becoming narrower, these devices stimulate and stretch the vaginal muscles.

Vaginal dilators can ease vaginal discomfort by expanding the vagina if painful intercourse is an issue. Although they are available without a prescription, your doctor could advise pelvic floor physical therapy and vaginal dilators if your symptoms are severe. You can learn how to utilize vaginal dilators from your doctor or a pelvic physical therapist.

Topical lidocaine

Topical lidocaine, which is sold as an ointment or gel by prescription, can be used to ease the pain brought on by sexual activity. Five to ten minutes prior to starting a sexual activity, apply it.

If you’ve had breast cancer

Inform your doctor if you have a history of breast cancer and take the following into consideration:

• Nonhormonal treatments. Moisturizers and lubricants may be utilized initially.
• Vaginal dilators. A non-hormonal alternative that can energize and expand the vaginal muscles is vaginal dilators. This aids in stopping vaginal narrowing.
• Vaginal estrogen. If nonhormonal treatments don’t relieve your symptoms, your doctor might suggest low-dose vaginal estrogen after consulting with your oncologist. Vaginal estrogen may, however, raise your risk of the cancer returning, particularly if your breast cancer was hormonally sensitive.
• Systemic estrogen therapy. Systemic estrogen treatment generally isn’t recommended, especially if your breast cancer was hormonally sensitive.