Filed under: Hormonal. Tagged as: Hormonal.
Oestrogen-containing vaginal preparations are often used by women in whom vaginal dryness makes sex distressingly painful. You may also benefit from these preparations if you have urinary symptoms such as a need to urinate frequently, or you experience recurrent urinary tract infections. Severe symptoms of this kind may need more far-reaching hormone therapy.
The oestrogen is absorbed into the bloodstream through the cells lining the vagina, and its major effect is in the immediate vicinity of the vagina and bladder. It is also carried to other parts of the body, including the uterus. For this reason, if you have an intact uterus and use vaginal creams, tablets or pessaries more than three times a week, you should probably be taking an oral progestogen for ten to fourteen days every three months. This ensures that any build-up of endometrial tissue is shed as a withdrawal bleed or, if no bleeding occurs, it provides reassurance that the endometrium is not in any danger.
Hormone rings, which sit in the top of the vagina for three months before needing to be replaced, release a small and constant stream of oestrogen that is absorbed by the cells of the vagina and cervix. Once again, if your uterus is intact you should take a ten-to-fourteen-day course of progestogen every three months to ensure that stimulation of the endometrium does not occur. These devices are on trial in Australia at the time of writing.
Advantages of these forms of local therapy include a concentrated dose of oestrogen at the site of the symptom rather than its widespread dispersal through the body.
Disadvantages include the lack of effect on other menopausal symptoms (such as hot flushes and night sweats); the rare occurrence of unexpected spotting or bleeding or endometrial hyperplasia (excessive thickening of the uterine lining) if used too frequently without added progestogen; their messiness; and the embarrassment felt by some women about putting things into their vaginas.