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OUR GENERATION got screwed, in the words of one 60s-something DC lawyer, referring to the panic among women and refusal by doctors to prescribe oral hormone replacement therapy (HRT) for menopause-related symptoms—from painful sex to brain fog— based on a 2002 study since shown to be flawed.
“There has been almost a generation of women who have mostly been denied the opportunity of improved quality of life during their menopausal years,” according to the “fact sheet” prepared by the Women’s Health Concern and reviewed by the British Menopause Society.
Dubbed the “menopausal vagina monologues” by the New York Times, genitourinary syndrome of menopause (GSM) continues to plague post-menopausal women, notably during vaginal sex—with pain that burns, stings or throbs as well as painful contractions during penetration.
Vaginal discomfort affects about 50% of postmenopausal women, and more than 50% of sufferers avoid intimacy as a result. GSM can affect quality of life, including self-esteem and relationships,
HRT is “the most effective solution for the relief of menopausal symptoms..also effective for the prevention of osteoporosis..may provide protection against heart disease,” the British fact sheet states. Research since the flawed WHI study has linked HRT to a reduced risk of heart disease and several cancers, including breast and colon, along with protection against osteoporosis.
From the Mayo Clinic: “systemic estrogen remains the most effective treatment for the relief of …vaginal symptoms of menopause such as dryness, itching, burning and discomfort with intercourse.”
During the decade following the onset of menopause, arteries often begin to narrow, and estrogen can cause the clumping of platelets that clog narrowed vessels. Women who wish to start HRT in the years after menopause can have a variety of tests to assess plaque buildup and risk of heart disease, such as ultrasound and CT calcium scans—also used to help determine the need for statins.
In 2016, MyLittleBird wrote about the then-latest vaginal rejuvenation treatment for post-menopausal issues—the MonaLisa Touch laser—for which DC women were storming the first local ob-gyn practice to offer it. But disappointment has for most women, including the DC lawyer, relegated lasers to the long list of treatments tried and failed —and for the MonaLisa, most spent thousands of dollars out of pocket.
In 2018, the FDA warned about the lack of evidence and reports of side effects for “energy-based devices used to treat vaginal conditions and symptoms related to menopause.” Treatments like the MonaLisa Touch, the agency said, could cause burns, scarring, and chronic pain.
And vaginal estrogen tablets were no more effective than vaginal moisturizers or placebo tablets or gel in a recent Mass General study of 302 postmenopausal women. Yet low-dose vaginal estrogen therapy—insertable tablets, creams and rings—is “currently considered the best treatment for GSM.”
“I’m heartsick at the costly, foolish, and sometimes dangerous alternatives to HRT that women resort to for vaginal pain and other symptoms,” wrote Carol Tavris, co-author with LA oncologist Avrum Bluming of the book Estrogen Matters, in an email to MyLittleBird.
Since the publication of their book, along with podcasts and talks, Bluming has received dozens of letters from women around the world “desperate for HRT, who were on it, taken off it by alarmed physicians and are now suffering the consequences—relentless night sweats, insomnia, brain fog, etc. as well as vaginal pain,” according to Tavris.
The WHI researchers have since backed down on their conclusions, at least for vaginal estrogen creams, although the package insert still has the FDA’s strongest boxed warning. But to date most clinicians remain unwilling to prescribe HRT or they prescribe it only as a last resort after patients have spent time and money on other treatments. Women who wish to try HRT are advised to contact the North American Menopause Society as a resource for the few ob-gyns willing to prescribe it.
(Similar to what happened with autism and vaccines, despite flaws in the original study and despite every study since that disproved the original results, it can take a long time to remove fears and change minds, even among doctors.)
Based on a University of Nottingham study that showed no effect on the risk for blood clots among those using patches, creams, gels and injections to administer HRT, lead researcher Yana Vinogradova advises women who wish to try HRT to start with the patch.
Meanwhile, popular alternative treatments for GSM range from marijuana douches and vaginal dilators to lidocaine ointment that numbs the vagina. New drugs include steroid vaginal inserts such as the DHEA-containing Intrarosa and injections of platelet-rich plasma. Many GMS specialists recommend trying everything until something works—though rarely does that everything include HRT.
Every married woman the DC lawyer knows who is not taking HRT complains of pain and/or burning, and none of them are having vaginal intercourse. And, she says, those taking HRT not only feel better but have better-looking skin: “You can see which women are taking it.”
—Mary Carpenter
Every Tuesday, well-being editor Mary Carpenter reports on health news you can use.
I am so surprised to see your column on HRT. Apparently you do not hear from women who have not experienced hot flashes or painful intercourse. I am one such person. After checking with my mother to see if she regarded menopause as difficult and was told it was a minor annoyance I opted to forego HRT. I was 48 when I entered peri-menopause with spotty periods, had given birth twice, had not experienced miscarriages or painful intercourse and had no history of early onset of menopause or hysterectomy or any health problems during a long monogamous marriage with a single sex partner. My ob/gyn was chief at Sibley Hospital in DC for many years. My husband and I enjoy coitus more than ever. I have no dryness at all and we need no extra lubricants. In fact I have few wrinkles, headaches have ceased and I feel and act and look 20 years younger. Perhaps I am atypical, never having taken birth control pills. But I hope I am not alone.