For many women, menopause brings with it the onset of sexual pain. This wasn't much of an issue in the past when women didn’t live so long. "In 1900, the average woman died at 51 years of age," says sexual medicine specialist Andrew Goldstein, MD, an associate professor at George Washington University.
Treat it with estrogen?
The natural drop in estrogen causes the vagina to become drier and the tissues to become thinner, a situation that can cause pain during penetration. Using lubricants can help, but estrogen helps some women more.
Many women are concerned about taking estrogen orally—hormone replacement therapy or HRT—after a 2002 study suggested a strong link to breast cancer, but doctors have widely divergent opinions about that. Some found the study was flawed and believe that with the proper variety and dosage of hormones, the risk should be small. But a study published in 2007 suggests the decline in breast cancer since 2003 correlates to a decline in oral HRT prescriptions.
Creams versus HRT
The consensus is, however, that formulations that deliver the hormones directly to the vulva or vagina are safer. Local estrogen treatment won’t help with hot flashes and other menopause symptoms, but "you can achieve vaginal health without using systemic estrogen," says Irwin Goldstein, MD (no relation to Andrew), director of San Diego Sexual Medicine and the editor in chief of The Journal of Sexual Medicine. If this treatment does begin to affect menopausal symptoms, Dr. Goldstein suggests checking in with your doctor, because the estrogen may be entering your bloodstream.
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