This is the term for the vaginal, vulval and urinary symptoms that many women suffer from due to reducing levels of oestrogen. They can be the first symptom of the perimenopause or not develop until a woman is much older. However, once these symptoms develop, they will only get worse without treatment. Some women can suffer terribly with these symptoms, even leading to discomfort wearing underwear or tight trousers and unable to do activities such as cycling or running. Many women and indeed HCPs find it embarrassing to discuss these issues so there are many women suffering in silence.
Symptoms can include any or all of:
- vaginal dryness, itching, soreness or burning, pain during and after sex
- vulval dryness, itching, soreness or burning, splitting of the vulval skin
- watery vaginal discharge
- shrinking of the labia and clitoris, reduced sensation and ability to orgasm
- painful smears
- urinary frequency, waking at night to pass urine, urinary urgency, urinary incontinence, recurrent urinary tract infections or feeling you are about to come down with an infection, recurrent urinary tract infections after sex
These symptoms can be treated very effectively with local (vaginal) oestrogen products but the treatment has to be long-term or symptoms will return. Those with a long history of such symptoms may find it takes longer to feel any improvement. Local (vaginal) oestrogen comes in the form of a vaginal tablet, cream, gel, pessary or ring and is safe for almost every woman to use (see chart below). It is not generally recommended for some uterine cancers and also breast cancer patients on aromatase-inhibitors so they need to discuss their options with their oncologist.
MHT can also be very effective at managing these symptoms but at least 25% of women on MHT need to add in local oestrogen as well at some point. It is safe to use both systemic MHT and local oestrogen long-term.
Vaginal moisturisers and lubricants during sex can also be beneficial but it is important to choose products without any irritating or harmful ingredients. I recommend Sylk or the Yes products which can be bought online at yesyesyes.org.
Any patient with persisting vulval symptoms despite a trial of local oestrogen should see a HCP for an examination to exclude any other causes eg lichen sclerosus, lichen planus or vulval cancer. It is worth examining your vulval area with a mirror once a month so you can check for any abnormal areas e.g. white patches, a persistent lump, roughness, splits, lump or an ulcer.