Post-Menopausal Pain

Many women who come into our center feel as if they’re alone with their issues, or that we’ve never heard of their situation before. In reality, many questions and symptoms we hear from our patients are very similar to the next person! Here is one question we hear quite often from post-menopausal women:

“Sex with my partner is very painful now. I am dry, I often feel a burning sensation during sex, and last time I bled a little. Can you recommend anything that would be of help?”

If your symptoms are caused by atrophic vaginitis, which is an inflammation and thinning of the vaginal tissues, due to the lack of estrogen after menopause, then there are numerous treatment options. Over the counter options include using a lubricant during intercourse, water-based or natural, such as olive or coconut oil. (Be aware that the oils can damage condoms).  You can use vaginal moisturizers (examples Replens or Halo-Gyn) which are typically applied every 2-3 days.

The MonaLisa touch is a promising new, non-hormonal treatment. It is a laser treatment, that stimulates collagen production in the vagina and helps restore the vaginal mucosa. It is virtually painless, and typically requires 3 sessions. Many patients have been finding great success with this option.

If those are not effective, you may need hormone based treatment. Local estrogens, either cream, ring or vaginal suppository will help to restore the pH of the vagina as well as thicken the vaginal epithelium. The estrogen is absorbed through the vaginal skin, which limits the amount that gets into the bloodstream. Hormone replacement therapy (HRT) which is estrogen and progesterone systemically will help with the symptoms as well as treating other symptoms of menopause, although sometimes you may still need to use the local cream.

Osphena is a pill that works similarly to estrogen, but is not estrogen. It is taken in pill form, and its effects on vaginal tissue are similar to that of estrogen. It does increase the risk of blood clots and uterine cancer, and can have hot flashes as a side-effect.

Once you have found the treatment that works for you, the best way to keep things going smoothly is to make a few lifestyle changes. Cotton underwear and loose fitting clothes help. Soaps, perfumes and some detergents can be irritating in the vaginal area, so you will want to avoid that. Douching can change the vaginal pH, so you will want to avoid that too. Some studies have shown that vitamin D can increase moisture in the vagina, so it might be worth adding a vitamin D supplement. And sexual activity increases blood circulation to the vaginal and stimulates natural lubrication.

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