Diagnosis & Treatment

From teenagers just starting birth control to patients using estrogen suppression medications to combat endometriosis, your skin can change as estrogen levels drop. For some, it might feel like  yeast infection or burning on their vulva or vagina, while might experience pain in their urethra. It might feel like there is a drop of urine that won't come out. For many patients, the symptoms resemble a bladder infection though urine cultures are usually negative and antibiotics are rarely successful. 

A diagnosis of GSM/Estrogen atrophy is based not only on your symptoms but also on how your skin looks. A trained gynecologist or urologist should see, easily, that the skin is changing appearance. If the vulva is showing signs of atrophy, then you can also assume that the vagina, the urethra and the bladder are also affected. Blood testing is optional though it may not reveal subtle changes that occur in skin when atrophy is just beginning. So, have your doctor take a quick look to see if your skin is noticeably changing. 

The most natural treatment that can be used is topical estrogen in a cream form. Why? Because when you give the skin estrogen, the cells immediately absorb the estrogen and begin to plump, grow and moisten with your natural lubrication.

According to the National Women's Health Network, "recent studies have shown that low-dose vaginal estrogen use does not have the same risks as hormone therapy. Data from the Women’s Health Initiative Observational Study showed that for postmenopausal women who used vaginal estrogen, the risk of invasive breast cancer, colorectal cancer, endometrial cancer, stroke, and blood clots was the same as those that did not. Using vaginal estrogen did not increase the risk of many problems associated with hormone therapy. The same findings held true for women who had had a hysterectomy."

They  continued "While some estrogen will enter the bloodstream from a local treatment, it is far less than with an oral treatment such as hormone therapy (HT). This reduces the risk of cancers and cardiovascular events associated with HT taken via pill or patch. Most of the estrogen will stay in the vaginal tissue so this type of topical treatment will not help with hot flashes or osteoporosis. "  

In the North American Menopause Society 2017 statement on hormone therapy they stated that “low-dose vaginal estrogen preparations are effective and generally safe for the treatment of VVA [vulvovaginal atrophy], with minimal systemic absorption, and preferred over systemic therapies when ET [estrogen therapy] is considered only for GSM [genitourinary syndrome of menopause].” The NWHN believes that, as the research currently stands, it appears that vaginal estrogen is a safe and effective treatment for vaginal discomfort due to menopause.  

However, if you or a family member have a history of cancer, blood clots, and/or heart problems, you'll need to talk with your doctor. Also, please let your doctor know if any spotting or bleeding occurs while using estrogen cream. 

There are a variety of over-the-counter products that may also be helpful. 

Soothing The Vulva

Products that provide a protective coating, such as Vulva Balm (V-Magic), can be applied to the vulva to protect the skin. These are often used daily. Coconut Oil is another option but it's quite a bit greasier and can stain clothing. Vulva Balm more closely mimics the natural texture of normal moist skin. 

Soothing The Bladder

For urinary symptoms that are not related to a UTI, products that contain chondroitin may help to coat the bladder wall, providing a little extra protection. These include Bladder Builder®, Bladder Rest®, CystoMend® and CystoProtek®.  Another option is AloePath® which can provide a soothing effect to the bladder and urethra and is often used during symptoms flares. Learn more about these supplements here! 

UTI Prevention

For those patients who are struggling with recurring UTI's confirmed by culture, face difficult challenges. The bacteria must be correctly identified and then treated with antibiotics. Patients with recurring e-coli infections may benefit from using a D-Mannose / PAC product which can help to flush bacteria out of the body. There are two dominant products: PRVNT® and ELLURA®.