The Grapevine

Postmenopausal Women Are Using Vaginal Estrogen To Keep Their Sex Lives Healthy — It's Worth The Risks

Menopause
A new survey finds one-third of postmenopausal woman are using vaginal estrogen to keep their sex lives healthy. Photo Courtesy of Shutterstock

Life is filled with plenty of compromises, especially when it comes to your health. Whether it’s passing on seconds of a scrumptious cherry pie or turning down an invite to an after-hours fiesta.

But a healthy life is defined by a lot more than a stable cholesterol count or the number of footsteps we take in a day. For many of us, the ability to be physically intimate with someone long into adulthood is crucial to ensuring our overall well-being. That’s a reality made particularly clear by a study published today in Menopause.

Surveying 310 postmenopausal women residing in New York, the authors found that many are turning to vaginal estrogen (VE) treatments to maintain the quality of their sex lives, despite the fact that hormone therapy as a whole has steadily declined in popularity over the past decade due to strongly supported fears that it unnecessarily increases the risk of developing breast cancer and cardiovascular disease.

Though systemic hormone replacement therapy is still recommended for women who go into menopause especially early (before the age of 40) or who experience severe menopause symptoms like excessive bone loss or intense hot flashes, it’s no longer the standard go-to treatment for menopause relief since the added estrogen may contribute to blood clot formation and breast cancer risk. The shift in policy came as a result of a 2002 study of over 16,000 women commissioned by the Women's Health Initiative (WHI) that evaluated the risks and benefits of preemptively dosing older women with a combination of estrogen and progestin.

"We have long sought the answer to the question: Does postmenopausal hormone therapy prevent heart disease and, if it does, what are the risks? The bottom-line answer from WHI is that this combined form of hormone therapy is unlikely to benefit the heart. The cardiovascular and cancer risks of estrogen plus progestin outweigh any benefits — and a 26 percent increase in breast cancer risk is too high a price to pay, even if there were a heart benefit. Similarly, the risks outweigh the benefits of fewer hip fractures," said Dr. Claude Lenfant, Director of the National Heart, Lung, and Blood Institute, in a statement at the time.

As this recent study showed though, postmenopausal women who wish to maintain a productive sex life have turned to applying low-level doses of estrogen to their vagina, either through a cream or the insertion of a ring or tablet. It’s a treatment that, while not able to prevent hot flashes or prevent bone loss, does appear able to restore natural lubrication to the vagina. The study found that those who reported having painful intercourse or vaginal dryness were the ones most likely to use VE treatment.

Most encouragingly, VE revitalized the sex lives of women who had since stopped hormone therapy, with these women scoring higher on a scale that measured their sexual quality of life than those who weren’t using VE. More than 35 percent of that group reported using VE, but even those who remained on hormone therapy supplemented it with VE, indicating that the inclusion of VE may provide its own unique benefits. All told, nearly a quarter of the women polled used VE.

“This implies that vaginal symptoms are important symptoms for menopause-age women, particularly for those who discontinue systemic hormone therapy,” the authors concluded. Though it’s currently believed that VE therapy is much less riskier than its cousin, since the estrogen is rarely absorbed by the body, they do also note that there remains work to be done in validating that belief with long-term studies.

Still, the study underscores the need to address the particularly valid concerns that these women have about their sexual fulfillment, in order to find the best compromise available.

"We know that estrogens play a key role in maintaining vaginal health," said Dr. Wulf Utian, founder and Executive Director of the North American Menopause Society, in a statement . "Not only do they assist with lubrication, but some studies also show them to be effective in preventing urinary tract infections. That's why women need to have more estrogen options and be educated on their benefits and potential risks."

Source: Setty, P, Redekal L, Warren M. Vaginal estrogen use and effects on quality of life and urogenital morbidity in postmenopausal women after publication of the Women's Health Initiative in New York City. Menopause. 2015.

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