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Support and treatment for vaginal and vulval changes in peri and post menopause.



What support and treatments are available?





As the changes to the vulva and vagina generally continue to worsen over time there is nothing that can really prevent it or reverse it except for estrogen.


Topical oestrogen – estrogen can be delivered to your vagina through a cream, vaginal tablet, or vaginal ring. It is considered a safe way to restore estrogen to the vagina and vulva without the concern of systemic absorption, there is an initial blood peak and then minimal further absorption after that. It reverses atrophic changes to the tissues and increases blood flow to the epithelium (lining) of the bladder and the vagina and the microbes change to become more lactobacilli dominant. It is generally considered a safe option if you are concerned about cancer risk and other potential health problems.

If you are taking Menopause Hormone Replacement therapy (MRT), it used to be known as (HRT), you can still use topical estrogen and many women do this.

It can create a change quite quickly if women are given the correct treatment and it is applied regularly enough.


The internal and external application of oestrogen improves lubrication, reduces burning, decreases the pH, increases blood flow that fills and plumps the vulva and the whole area internally and externally.


If you are concerned about the effects of estrogen, know that a year’s supply of local estrogen is the equivalent of taking one tablet of the lowest dose HRT.


Ovestin and Vagifem do contain lactose, which is not appropriate for everyone, if you are lactose intolerant it may cause irritation. If you get hormone replacement from a compounding pharmacist, ensure you ask for a neutral lipid base – non allergenic.

If you do, or have had hormone receptive cancer, discuss with your doctor whether this would be the correct treatment for you or not. For some women, their suffering is unbearable, and they choose to use it.


Please note that there is an estrogen replacement drug that is called Premarin that is sourced from pregnant horse’s urine!! If you are concerned about the treatment of animals know that the collection of mare’s urine is a very cruel process for these animals, and they suffer terribly. Personally, the thought of putting something on or in my body that is made of urine is quite off putting. There are cruelty free and healthier options available, please talk to your doctor about them.



 

Vaginal moisturisers


You can trial a vaginal moisturiser first before using estrogen and if used effectively it can be as helpful as vaginal estrogens. Everyone has different responses.

Vaginal moisturisers keep the vaginal tissue moisturised and plumped up, but moisturisers do not contain any hormones.


YES brand - considers pH and osmolality. They make specific moisturisers for menopause and offer a water and oil-based lubricant. You could try the moisturiser first and apply every two days. It is meant to lubricate and moisturise for 2 days but may need to be used more often. Some people do have a burning reaction so you may need to use it in conjunction with something else like oils and topical relief and mix lubricants. You can use with herbal pessaries in an oil as that helps to reduce inflammation and dryness, but they are applied at different times of the day.

The YES products are organic, do not contain any synthetic chemicals, are pH balanced and contain no glycerine or silicon. YES, is an internal moisturiser. They also have a range of natural lubricants for sex.


The website for more information is: https://yesyesyesaustralia.com.au/



Olive and Beeis a moisturiser and only contains olive oil and beeswax, it is used externally.


https://www.oliveandbee.com.au/



V magicis an external moisturiser and contains natural ingredients and has many rave reviews.


https://au.iherb.com/pr/Medicine-Mama-s-Vmagic-Intimate-Skin-Balm-2-oz/73162


Please note, I am not affiliated with these companies in anyway, nor do I receive kick backs. I just want to let you know what safe and good quality products are available. As more options become available I will review them.



 

Plant based hormonal support


Red clover


80 mcg of isoflavones daily has shown an improvement in vaginal atrophy. Promensil contains red clover and may assist in reducing the symptoms of vaginal atrophy and other symptoms of menopause. You could take red clover as a tea for the long term or make herbal infusions.


Black Cohosh


Can improve vaginal atrophy in post-menopausal women.


Alfalfa


Is rich in phytoestrogens and is sometimes used in protocols for vaginal dryness.


Calendula


It is a wonderful herb for healing vaginal tissue that has minor abrasions. It may help to reduce infections and is applied topically.


I will be writing another post where I will go into more details around herbal support.



 

Pessaries





Key-E suppositories


Contain vitamin E in a base of coconut and palm oils. They are soothing and moisturising and many women get a lot of relief from them. Please note they do contain partially hydrogenated coconut oil. You can purchase them from:


https://au.iherb.com/pr/carlson-labs-key-e-suppositories-24-soothing-inserts/2787



Fennel pessaries



Fennel pessaries need to be used daily for 8 weeks to see changes. You can have them made up from a compounding chemist, but I will show you how to make them in another post/video so you can do it yourself at home.



Vitamin E pessaries


Research shows 100IU vitamin E capsule inserted vaginally over 12 weeks minimum every day relieves the symptoms of vaginal atrophy especially in women who are unable to use hormone therapy. (parnum et.al 2016)



 

Diet


A diet high in plant estrogens can help many menopausal symptoms including vaginal dryness. Foods that are supportive of this are:


Flaxseeds





Flaxseeds need to be ground. They are high in omega 3’s so help to reduce inflammation and improve skin dryness. 2 tablespoons of ground flax a day would give you your recommended daily intake of omega 3’s and a nice dose of plant estrogens, this amount has been shown to reduce post-menopausal vaginal atrophy.


Organic soy, miso, tempeh and natto


Legumes – alfalfa, lentils, chickpeas, pinto beans, lima beans, red clover, sunflower seeds



 

Supplements


Sea buckthorn oil



Studies have shown that taking 3 grams daily of Sea Buckthorn oil over a 3-month period showed improved tissue integrity and lowered pH. It didn’t improve burning, itch or irritation so other therapies are needed for that. If the atrophy isn’t really severe great improvements can occur with sea buckthorn. (larmo et.al, 2014)


In Australia BioCeuticals have a product called Alpha EFA which you can purchase from health food shops and some chemists. It is a vegetarian source of omega 3,6,9 and 7.


 

Laser Therapy

Mona Lisa Touch


The Mona Lisa touch is a vaginal laser therapy. It can be very successful for some women and for others it doesn’t make a difference. There is evidence for effectiveness but not long term and there is not long-term evidence for safety. It can provide 12-18 months relief.


For more information go to their website http://www.monalisatouch.com.au/



 

RESOURCES and SUPPORT



BOOKS


My menopausal Vagina by Jane Lewis


A wonderful resource sprinkled with a good dose of humour.


https://www.amazon.com.au/Me-Menopausal-Vagina-Jane-Lewis/dp/1916446701




Menopause by Dr Louise Newson

Written by a GP specialising in menopause. Up-to-date evidence based information.


https://www.amazon.com.au/Menopause-Concise-Manual-Louise-

Newson/dp/1785216422



 

WEBSITES


www.menopause.org


https://dianedanzebrink.com/


https://www.menopausedoctor.co.uk/


 

REFERENCES


Farrell Am E. Genitourinary syndrome of menopause. Aust Fam Physician. 2017;46(7):481-484.


Kim HK, Kang SY, Chung YJ, Kim JH, Kim MR.   The Recent Review of the Genitourinary Syndrome of Menopause.   J Menopausal Med. 2015 Aug;21(2):65-71. https://doi.org/10.6118/


Larmo PS, Yang B, Hyssälä J, Kallio HP, Erkkola R. Effects of sea buckthorn oil intake on vaginal atrophy in postmenopausal women: a randomized, double-blind, placebo-controlled study. Maturitas. 2014;79(3):316-321. doi:10.1016/


Mac Bride MB, Rhodes DJ, Shuster LT. Vulvovaginal atrophy. Mayo Clin Proc. 2010;85(1):87-94. doi:10.4065/mcp.2009.0413


Mitchell ES, Woods NF, Mariella A. Three stages of the menopausal transition from the Seattle Midlife Women's Health Study: toward a more precise definition. Menopause. 2000;7(5):334-349. doi:10.1097/00042192-200007050-00008


Moradan S, Ghorbani R, Nasiri Z. Can vaginal pH predict menopause?. Saudi Med J. 2010;31(3):253-256.


Stute P. Is vaginal hyaluronic acid as effective as vaginal estriol for vaginal dryness relief?. Arch Gynecol Obstet. 2013;288(6):1199-1201. doi:10.1007/s00404-013-3068-5




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