Hormone Replacement Therapy

The Vagina is Like Las Vegas, Baby!

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What happens in Las Vegas stays in Las Vegas, or so they say. Well I say, what goes in the vagina stays in the vagina!

A few years ago, I made that statement on the Dr. OZ show while talking about vaginal health during perimenopause and menopause. This is my favorite way to introduce a very important topic that causes so many of you great embarrassment.

All of us will begin to experience vulvar and vaginal changes, collectively referred to as atrophy, once we begin our menopause transition. These changes are caused by a decrease in estrogen levels, which lead to thinning, dryness, decreased elasticity and sometimes inflammation of vulvar and vaginal tissues. I like to think of the vulva and vagina as becoming more dainty and delicate. At least 50% of us will experience some degree of burning, irritation and itchiness within a few years of our last menstrual period. And for those of you who are sexually active, sex will very likely be painful.

There are many effective non-medical treatments to help prevent and treat vulvar and vaginal atrophy due to perimenopause and menopause. I recommend weekly masturbation, with or without a vibrator. Did that shock any of you? I hope not. Masturbation is the most inexpensive and natural way to achieve the health goal, because it increases blood flow to the genital tissues. What if you have no libido or interest in doing this activity? I offer you the motivation of improved vulvar, vaginal and bladder health. Just like we have to engage in aerobic exercise for our hearts, we also have to do something to help out our pelvic area. It is the very least that we can all do to prevent a major quality of life issue down the menopause road.

There are also natural vaginal moisturizers that you rub directly onto the vulva and vagina tissues like olive or Vitamin E oil. No need to buy expensive olive oil for this purpose, by the way. Vaginal moisturizers need to be used daily, just like facial moisturizers do. They are different from vaginal lubricants, which are only used to help with insertion of a penis or vibrator during sex. You can find many over-the-counter choices of moisturizers and lubricants at your local pharmacy.

So here is where the title of this blog gets explained. You can also use local estrogen directly on the vulva and vagina to treat the symptoms of atrophy due to menopause. The concept of using local estrogen means that the estrogen does not leave the vagina and travel elsewhere, like to the breast. When estrogen is used locally for vaginal dryness, it is not absorbed into the bloodstream. So women can use local vaginal estrogen without worrying about increasing their breast cancer risk. In fact, breast cancer survivors can safely use local vaginal estrogen to prevent and treat their symptoms of vaginal dryness and painful intercourse.

Local estrogen restores blood flow, improves tissue elasticity and vaginal pH and plumps up the cells so they can resume their ability to lubricate once again. That is, by the way, the key difference between estrogen and non-hormonal treatments, which do not restore the physiologic health of the vulvar and vaginal tissue. Even though the FDA mandates that the package insert of the local vaginal estrogen preparations carry all the same warnings as the systemic estrogens, you now know better.

So Viva Las Vegas! When it comes to local estrogen use, what goes in the vagina really does stay in the vagina!

Tara Allmen, MD Credentials:
– Board Certified Gynecologist and Nationally Certified Menopause Practitioner
– New York City’s Leading Expert In Menopause
– President, North American Menopause Society Foundation
– Fellow of the American College of Obstetrics and Gynecology
– New York City’s Top Gynecologist, 2015
– Five Star Rating From Doctor’s Choice Awards
– Five Star Rating From HealthGrades

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