Senior Living: Menopause can mean pain

It’s important for women to watch out for signs of trouble and take action.

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This column is not about me. I have never woken up at night with such an itchy vagina, I considered using a toothbrush. I never fidgeted vigorously while sitting in my chair, like a hyperactive toddler, in order to convince my insides that they felt fine.

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But even though this column is written, you know, for the benefit of a friend, it’s also relevant to the nearly four million Canadian women over the age of 65 (and hundreds of thousands under) who may be affected by vaginal itching. and other postmenopausal symptoms that persist years after their periods have ended.

The symptoms are part of genitourinary syndrome of menopause (GSM for short), a condition associated with the decline in estrogen that accompanies aging.

It can manifest as itching, dryness, burning, and irritation in the vaginal area, but also as other confusing symptoms that non-doctors wouldn’t necessarily associate with a lack of estrogen, including recurrent urinary tract infections and an urgent need to pee. (Estrogen receptors are located throughout the body, including the bladder, vagina, and vulva.)

Because symptoms can come and go, and can be difficult to bring up even in conversations with girlfriends (who normally talk about everything), let alone doctors – it’s easy to push the GSM to the back of the brain with d Other things you don’t do that you want to think about, including personal guidelines and what to do with all those photo albums.

But after an in-depth conversation with obstetrician and gynecologist Dr. Nan Schuurmans, I’m here to suggest that itchy vaginas shouldn’t be ignored. They deserve their day in the sun, or its more modest alternative – the bright little light at the “scooch-your-bum-down-here” end of the doctor’s examination table.

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“There are a lot of people who have it who don’t know it and don’t tell their GP about it,” says Schuurmans, founding physician and medical director of the menopause clinics at Lois Hole Hospital for Women and the Gray Nuns. Edmonton Hospital.

Although GSM can occur in younger women, according to an article by the North American Menopause Society, it affects between 27 and 84 percent of postmenopausal women and can significantly impair health, sexual function, and quality of life. .

Yet despite its prevalence, GSM often goes untreated. In a US survey of 1,858 postmenopausal women with genitourinary symptoms, half had never used treatment for the problem. The lack of assessment and treatment, according to the 2020 article, is due in part to the reluctance of women and healthcare providers to talk about GSM, and to safety concerns with the use of hormone therapies. .

But without treatment — either because you don’t know you have it and/or your doctor didn’t bring it up during pelvic exams — the condition can get worse.

“It can be mild, starting with vaginal dryness, but there are huge individual variations with symptoms,” says Schuurmans. “(Patients) can have pretty bad results and think that’s normal for aging. But it’s not normal to get old… we don’t necessarily all understand that. Our tissues are all different.

She mentions a recent case in which a woman came into her clinic with an abnormal Pap smear, as well as bleeding and pain during intercourse. An examination revealed a shortened and inflexible vagina, and cervical changes associated with a lack of estrogen. There didn’t seem to be a cause for the abnormal Pap smear, but six months after the patient was put on estrogen, the pain was gone and her Pap smears were normal.

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Of course, even raising the issue of estrogen replacement can stoke fear among women and doctors who associate hormone therapy with rose risks, including cancer. But it’s important to remember that there are a variety of remedies (even outside of systemic hormone replacement therapy) that are available to treat a range of GSM symptoms. If a woman only has, say, an itchy vagina and is not plagued by other post-menopausal issues such as hot flashes, a simple over-the-counter vaginal moisturizer containing acid hyaluronic acid can provide relief.

Vaginal suppositories, intravaginal rings, and creams containing small amounts of estrogen, available by prescription, may also relieve symptoms. Preparations containing DHEA, another type of hormone, have recently become available in Canada for women who do not want to use estrogen. The 2020 research paper mentioned earlier in this column notes that herbal supplements, including black cohosh, appear to be ineffective in treating GSM.

Sex and orgasms, enjoyed with a partner or a vibrator, help maintain healthy blood flow to the genital area, which lubricates the vagina and life in general.

Although both underdiagnosed and undertreated, GSM can be effectively managed. But Schuurmans says many busy healthcare providers, including gynecologists, don’t have the time or even the expertise to appreciate the intricacies of GSM and can end conversations that have taken a lot of courage from women to initiate in the first place.

Schuurmans stresses the need to take charge of your own vaginal health.

“For women, it’s very important to educate themselves and realize that they have to defend themselves,” she says.

— Liane Faulder writes the Life in the 1960s column.

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