I want to talk about our vaginas. Yes. Our vaginas, and our bladders for that matter. If you have entered menopause they might be shrivelling and sagging.
This is a horrifying thought for any women, and the reality for over 50 per cent of all women within three to ten years of entering menopause. The condition is referred to as Vaginal Atrophy (VA), Urogenital Atrophy (UGA), Atrophic Vaginitis and Genitourinary Syndrome of Menopause (GSM). VA is where the vaginal walls become thin, fragile and inflamed due to a reduction of estrogen. What is VA?
The sad thing about this condition is not the condition itself, because it is quite treatable; the sad thing, is that so few women know about it. Often feeling alone in their plight, women all over the world suffer needlessly in silence, too embarrassed to discuss their symptoms. Well, I for one would like to help change this situation. As a nurse and a women in pari-menopause running Fabulous@50 Calgary, I have a vested interested in women’s health issues.
A couple of weeks ago I had the privilege of interviewing several wonderful women regarding this condition, and learned more than I had anticipated. The women were part of an initiative to increase awareness of VA. They are part of The Dedicated Influencers on Vagina Atrophy (DiVA) Circle and appeared at the Calgary Woman’s Show with Dr. Marla Shapiro. Their message was well received by the audience: Let’s Start Talking VA www.starttalkingva.ca
The first 2 women I interviewed were medical doctors with a specialty in Women’s Health. (Please see bios below)
My first interview was with Dr. Vivien Brown. I was immediately struck by her knowledge, her passion for women’s health issues and her ability to communicate her message so clearly. Our conversation lasted much longer than originally planned; indeed I would have happily engaged in this conversation for even longer. I was learning so much as both a woman and a nurse. Dr. Brown shared with me the common symptoms women suffer from, including the physical, emotional and relational impact this condition can have. We discussed the reasons this happens to our bodies and the treatments that are available. Most importantly, we discussed the barriers that block women from seeking support and what is needed to remove these barriers.
Most of us understand the basics of menopause but lack depth o f understanding of what really goes on within our bodies. There is such a myriad of symptoms that can occur so that it is hard to know what is normal, what is not; what is treatable and what is not. Most people associate menopause with hot flashes, mood swings, night sweats and our periods getting fewer and farther between until they eventually stop altogether. We know that these symptoms will eventually pass. We laugh and joke about these symptoms and we openly discuss them.
But… do we talk openly about our vaginas… and what happens below the belt once we enter menopause? No! Not typically. There seems to be a conspiracy of silence when it comes to talking about something as intimate as our vaginas and genital areas. Most of us rarely even use the word vagina. If you are like most women you likely have a nick name for this part of your body. Lady parts, Vjay jay, hoohoo and the list goes on. Even with a nick name, most are too embarrassed to discuss the topic, even with their doctors. But what if they are giving you grief? Burning, Itching, painful sex, lack of lubrication? Are you suffering in silences and embarrassment? These are not topics casually brought up in conversation. Unless, of course, you have been hanging around me for the past several weeks. I somehow find a way to bring up the conversation no matter what the situation. Vaginas have been a taboo topic for far too long. Their health and functioning is part of our overall health functioning. Therefore let’s chat about vaginas shall we?
As we enter menopause, our hormones fluctuate and decrease as they are no longer needed to trigger ovulation and menstruation. During the fluctuation period (pari-menopause) we might experience those common symptoms of hot flashes, sleep disturbances, night sweats and mood swings. Once we are in menopause and hormones stabilize, our estrogen is significantly lower than what it is as a young woman. Vaginas and the back wall of the bladder are dependant on estrogen, so once we experience lower levels of estrogen, the functioning of these organs can change. As a result, we may develop symptoms such as urgency (needing to pee now), frequency (peeing often) and dribbling, especially during laughter. These symptoms are often misinterpreted as bladder infections. Our vaginas can also suffer. With lowered estrogen levels, vaginas and genital area start to thin; loose their elasticity; become dry and easily inflamed. The symptoms experienced are burning, itching, dryness, irritation and pain during intercourse. These symptoms are often misinterpreted as yeast infections. As you can see, a lot of misinterpretation can lead to improper treatment or lack of effective treatment altogether. When interviewing Dr. Mangat, she stressed that VA is under recognized and under treated.
The most important step a woman can take is to be proactive in initiating the conversation, both with her doctor and her partner. VA does not just affect the woman, it also impacts her partner. Often when a woman experiences pain during sex she does not let her partner know, she simply starts to pull away and avoids sex. She may feel less appealing and her overall self esteem can be at risk. Her partner then may feel rejected and their self esteem can also be affected. It is easy to see how this is a downward cycle which decreases overall intimacy and satisfaction within a relationship. Dr. Brown cited The CLOSER survey (CLarifying vaginal atrophy’s impact On SEx and Relationships) survey, in which thousands of couples were involved. The survey aimed to determine the emotional and physical impact of vaginal atrophy on postmenopausal women and their partners. The conclusion: Vaginal discomfort impairs quality of life in postmenopausal women and their partners. It is time to start the conversation with: your partner, your health care provider and other women.
Both doctors confirmed that the first step in getting proper treatment is to get properly assessed. Your health care provider will ask many questions and can do an internal exam to see if you are showing physical signs of VA. Now that the recommendation for PAP smears is for once each 3 years (if your PAPs have been normal), it is vital that you still discuss any vaginal issues with your doctor during your annual check up. I mentioned the conspiracy of silence earlier. Here is how it can play out: A woman is too embarrassed to mention painful sex to her doctor. Meanwhile the doctor expects the patient to mention any issues. The woman then assumes that, since the doctor didn’t say anything, there is nothing to be done. And the science continues. Dr. Brown lectures at continuing education for doctors to help improve their proactive questioning skills. We women must do our part in being our own best advocates and proactively speak up.
Speaking up is the message from both Joan and Donna; two vibrant women who once suffered so badly from their symptoms that they each had little to no quality of life left. Joan had entered menopause early and, by the time some of us start the process, she was unknowingly suffering severely from VA. She had all the symptoms of burning, itching and irritation. She shared that, for years, she had played the blame game. “It must be the chlorine in the pool irritating me”. So she stopped swimming. “It must be riding my bike that is an issue”. She stopped cycling. Sex was painful, so that dropped off too. She felt she had little quality of life. Once she was properly diagnosed and treated, her life dramatically changed. She is now vibrantly enjoying ALL aspects of her life again, she told me with a wink and a smile. She happily plays ambassador to increase awareness and help other women know they are not alone. Donna shared a similar story of suffering from VA without knowing. She told me that she blamed her symptoms on external factors irritating her. She suffered frequently from UTIs (Urinary Tract Infections). Neither her nor her doctor initially suspected VA since she was on HRT (Hormone Replacement Therapy, which is taken orally). They did not realize that HRT does not effectively treat VA. VA is best treated locally with LET (Local Estrogen Therapy). It was a pharmaceutical friend who helped Donna figure out what she needed to do. Armed with her new education, she returned to speak with her doctor. Together, the two of them figured out the best course of treatment for her. She too was amazed at how well she responded to treatment. She happily says she has not had a UTI since starting treatment. Donna is single but stresses that it is still vital for all women to care for their vaginal and bladder health, regardless of their relationship status. Her biggest lesson was that HRT does not fix VA.
So what is LET all about? Currently the best practice for treating VA is Local Estrogen Therapy (LET). Recently updated guidelines from The Society of Obstetricians and Gynaecologists of Canada (SOGC) continue to recommend low-dose local (vaginal) estrogen therapy for the effective treatment of VA. Treatment options include a vaginal tablet, cream or a ring that is inserted every three months. Both doctors stressed that the treatment has been deemed very effective and safe. The estrogen is a very low dose and studies show that the estrogen is taken up by the estrogen receptors of the vagina and bladder and that it does not enter the blood stream. They stressed that it is very different than taking estrogen orally as in HRT. There is a variety of products on the market, so it is important for you to educate yourself and discuss the options with your health care provider. Each woman is a unique person so choice of treatment will vary.
At the end of each interview I requested the top three points they wished to convey to women about VA and related issues. There were common themes, so here is a summary of what I learned:
- Communication: Start the conversation with your partner, health care providers and other women.
- Education and Awareness: Educate yourself regarding symptoms and available treatments.
- Watch for symptoms: Burning, itching, irritation, inflammation and pain during intercourse, UTIs, bladder control issues.
- Seek Professional Assessment: Do not make assumptions as to cause of symptoms. Get a proper examination from a health care provider.
- Treatment: Studies show that LET is effective and safe. LET and HRT treat different issues and can be used together.
- VA Worsens: Unlike other menopausal symptoms, VA does not go away; it worsens with time. It is treatable at any stage and any age. Degree of recovery will vary.
- Follow Up: Treatments can take time to be effective. Keep the line of communication going. If one treatment does not work, another might.
Now Ladies… it’s time for your call to action: Be your own best advocate. Be proactive with your health. Attend a seminar on women’s health and menopause. Help others along the way by sharing your stories of success. Let’s Talk about Vagina’s During Menopause.
Below you will find links to online websites that might help you in your education process. You are not alone if you suffer from these symptoms.
Start Talking VA
Dr. Vivien Brown
Calgary-based Dr. Rupinder Toor Mangat Medical Director & Founder, NE Calgary Women’s Clinic and Clinical Lecturer, University of Calgary
- Provided a local viewpoint, shared her expertise/tips based on what she sees at her clinic and shed light on the cultural sensitives around discussing VA and breaking the ice.
Visiting from Toronto, Dr. Vivien Brown Vice President of MEDISYS Health Group, and certified menopause expert
- Shares her menopause expertise and results from studies including the CLOSER study that showed the impact of VA on women and their partners.
Canadian Boomer, Winnipeg resident Joan Boone, started experiencing symptoms of menopause/VA at an early age; has boldly emerged from the shadows to share her personal story (how VA impacted intimacy, etc.)
- Talks candidly about menopause and how to live fabulously–relevant for all women, as every woman will experience menopause! Joan is captivating.
Canadian Boomer, BC resident Donna Deis, while attending a forum on menopause issues, Donna realized she was experiencing many of the symptoms discussed – including vaginal atrophy, and wants to share her story.
- Talks about how she hasn’t let VA stand in her way of doing what she loves – golfing, gardening, etc. Donna is trendy and enthusiastic, with a drive to show others how you can enjoy this time in your life.
Joanne Neweduk is the Director and Community leader for Fabulous at 50 Calgary. She is a mother of three young adults, a registered nurse, a certified life coach, and facilitator. She has a background in oncology nursing and has recently updated her nursing skills through Grant MacEwan University. Joanne has a decades long involvement with volunteerism, event planning, and is currently the president of a humanitarian charity, Medical Mercy Canada. She is enthusiastic with every endeavour she takes on and derives great joy from collaborating with others and creating new adventures. Fabulous@50 is her latest new adventure.