I get to look at this lady every day in my treatment room
Day 2 of Women’s Health Week is devoted to Happy Hormones – here is the link to Jean Hailes’ articles about hormones. I thought my contribution would be to post some info about when local oestrogen may be advantageous to improved pelvic floor function.
Local vaginal oestrogen can be helpful through different life-stages for women. One of those stages can be whenever you are breast feeding.
Breastfeeding may suppress your monthly menstrual cycle due to high levels of prolactin (a breastfeeding hormone) competing with oestrogen and progesterone production. As time progresses following the birth, the atrophic vaginal tissues can not only impact on prolapse and incontinence, but also may cause dryness and subsequent pain with intercourse. You cease the local oestrogen as soon as you stop breastfeeding.
Another stage is when you become peri-menopausal and post menopausal. It is useful for plumping up the urethral and vaginal tissues which helps with continence control and with comfort in the vagina with penetration during intercourse. Any changes in the ability of the smooth muscle sphincter mechanisms to provide good urethral closing pressure will contribute significantly to stress incontinence and insidious leakage. The urethral sphincter mechanism also deteriorates with ageing due to decreased vascularity and will benefit from oestrogen supplements locally to help after menopause with maintaining urethral closing pressure. Discuss the use of local oestrogen cream or tablets (inserted into the vagina) with your general practitioner or specialist if you are having continence issues or painful sex.
- There is considerable data to support the use of topical oestrogens in urogenital atrophy.
- Topical oestrogens should not be deposited deep in the vagina, but rather in the anterior portion, in order to minimise uterine exposure and to maximise the effect on the vulva, urethra and clitoral areas.
- Oestrogen creams may be best used by abandoning the applicator all together and placed on a finger instead. This is then inserted inside the anterior vagina; some cream should also be smeared onto the vulval skin.
- Patients who have had breast cancer should use nonhormonal moisturisers first and topical oestrogen as a last-resort.
- Vulval dryness may respond to soap-free washes, using plain moisturisers on the vulva and intravaginal moisturiser products. Natural oils (such as coconut oil or olive oil) can be effective lubricants.
Mona Lisa Touch Therapy laser treatment
Since 2013, a non-surgical, non-hormonal alternative to vaginal atrophy has been available in Australia and around the world. This is a laser treatment (Mona Lisa Touch Therapy) which stimulates the body’s regenerative processes to create more healthy and hydrated cells and to improve the vascularity of the vaginal mucosa. I have written a previous blog on the Mona Lisa. It costs around $2000 in Australia for the 3 treatments necessary and is not covered at all by Medicare at the moment. This may be a useful option if the patient has vaginal atrophy and has had an oestrogen-dependent cancer and is advised not to use local oestrogen. Discuss this with your specialist or doctor.
I hope these titbits help you start some conversations with your medical practitioners.