“Going through the change.” That’s code for menopause and the wide range of uncomfortable, frustrating and/or bewildering symptoms women may experience in the early, mid or late stages. The phrase might sound a bit old fashioned but that’s basically what’s happening: physical changes – specifically the decrease in estrogen – trigger the hot flashes, night sweats, moodiness, irritability and other complaints commonly associated with the transition (1).
Other symptoms are more “delicate” in nature. Genitourinary syndrome of menopause refers to problems with the genital system (e.g. vaginal dryness, itching, burning, soreness, painful intercourse) or the lower urinary tract (infection, increased frequency of urination or urinary incontinence) (2).
But while the hot flashes and other symptoms usually subside once “the change” is complete, genital and urinary symptoms can persist and rarely go away without treatment (3). It’s a widespread and distressing problem affecting around half of all postmenopausal women (4) with the most commonly reported symptoms being vaginal dryness and itching/irritation (5). And yet, it’s a significantly underreported and undertreated condition; only a quarter to half of women experiencing symptoms seek medical attention (4;6).
That’s unfortunate, because effective treatments are available in the form of vaginal estrogens: creams, gels, tablets or rings containing low doses of estrogen are applied to the vaginal area. They’ve been proven effective for vaginal symptoms (7) yet many women seem hesitant to start or continue using them (4;6). That prompted the Society of Gynecologic Surgeons (SGS) to conduct a new systematic review of the effectiveness and safety of vaginal estrogens with the ultimate goal of helping doctors and patients make informed treatment choices (8).
The review included 44 studies of varying durations that compared different types of vaginal estrogen to no treatment, a placebo, non-hormonal moisturizers or lubricants, or systemic estrogen (pills or skin patches that release hormones into the blood).
What the research tells us
For certain single symptoms – such vaginal dryness – over the counter lubricants and moisturizers may bring adequate relief. But for multiple or more severe symptoms, vaginal estrogens are recommended as the next step.
The evidence shows all types of vaginal estrogen effectively relieve symptoms of genitourinary syndrome of menopause (8). There was also some evidence that vaginal estrogens help reduce the frequency of urinary tract infection.
Although vaginal estrogens are considered generally safe and contain low doses of the hormone (little of which is released in the bloodstream), more research is needed to measure longer-term effects (8).
Menopause may be associated with decreased estrogen but it doesn’t have to mean a diminished quality of life. A consultation with the doctor and a prescription for vaginal estrogen may relieve those uncomfortable symptoms and result in a change for the better.