The climacteric and postmenopausal periods are important periods in women’s health and quality of life. The average age of menopause in Spain is around 51 years, with 83% of women of this age currently undergoing this period, which is fundamental for women, professionals and the health system.
According to the Study on Perceptions and Habits of Spanish Women during Menopause, more than 62% of Spanish women over 45 years of age are concerned about how this process may affect their health.
How does menopause affect health?
The gradual decrease in estrogens can lead to a series of related signs and symptoms that cause deterioration of vital capacity as well as an increase in the risk of certain disorders and pathologies. Hot flushes, dryness, mood alterations, insomnia and decreased libido are concerns that limit and condition a woman’s daily life.
Hormone replacement therapy, now called “hormone therapy of menopause” (HRT), is the first step in treatment, especially in the first years after menopause. However, following the results of the WHI study, which showed an increased risk of breast cancer, this treatment has been widely questioned and debated, and its use has been considerably reduced.
We refer to young women, from about 50 years old, in very good health and probably in their best professional and social moment and who start with vulvo-vaginal atrophy that is increasing and that limits them in their relationship life with their partner or with other partners, since according to the National Institute of Statistics in 2018 27.2 % of divorces occur in people over 50 years old, being the average age in women at 50.1 years old.
Limitations in sexual relations become apparent and are referred by the woman in her review. But on many occasions it is the partner who deals with the issue, which conditions and worries him, this being the main reason why he accompanies the woman to her gynecological consultation.
Data from the Spanish REVIVE study, which represents the largest cohort studied on the symptomatology of vulvo-vaginal atrophy, show that the most frequent associated symptom was dryness (81 %), while pain during sexual intercourse – dyspareunia – appeared in 25 %. However, dyspareunia proved to be the most bothersome symptom (74 %), as it has repercussions on the woman’s erotic-sexual relations and on her relationships with her partner. In this study the most significant impact of atrophy symptoms was in relation to the participants’ ability to enjoy sex. Seventy-five percent of the women reported that it interfered with their sexual satisfaction and 67% with their partner relationship; sexual spontaneity (66%) and intimacy (53%) were most frequently affected.
Chronic dyspareunia ultimately affects all phases of a woman’s sexual response. The sexual desire of the participants decreased overall by about 41% as a direct consequence of the symptoms of vaginal atrophy (39% in women with a partner and 50% in women without a partner, respectively). Subjective feelings of arousal and vaginal lubrication are also affected.
There is a widespread conception in older postmenopausal women that this is a problem that the woman assumes she would like to improve in order to please her partner.
Fortunately, younger couples, with more recent menopause, face this situation together and look to professionals for solutions. There is no doubt that the mechanical stimulation of intercourse improves lubrication and that the use of moisturizers and lubricants can improve the situation.
The use of moisturizers and lubricants can alleviate this deficit, although they generally do not compensate for the atrophy produced.
Local estrogens seem to be more effective, but the fear of using hormonal treatment, especially in women with a history of cancer, also limits their use.
These treatments are often insufficient and require a dependency that can interfere with sexual relations.
In the REVIVE study, the main concerns of women treated with prescription vaginal products were the inability of the treatments to restore the natural state of the vagina (33.3%), followed by long-term safety (22.7%), the long period of time needed for the medication to work properly (20.0%), unwanted side effects (17.3%) and implications for spontaneity in sexual relations (17.3%).
In general, all local treatments require continuous use and this fact is presumably the major conditioning factor, since adherence to treatment is low or very low in almost all the women who use these products.
Currently, new local treatments have appeared, such as prasterone, and oral treatments such as ospemifene. Both require continued use and this affects the acceptability of the method.
Laser therapy in the treatment of postmenopausal vulvo-vaginal atrophy
Laser therapy is now an important alternative for improving postmenopausal vulvo-vaginal atrophy. It is a comfortable option, in a few sessions, with good results that are maintained in the long term and devoid of estrogenic activity or other negative effects.
The null estrogenic effect is another of the great contributions of the laser for vulvo-vaginal atrophy. This fact makes it almost a treatment of choice for those women who cannot or do not wish to undergo hormonal treatments.
The laser as a treatment for vulvo-vaginal atrophy has among other advantages:
- Short treatments
- Prolonged effect
- Improved relations
- Personal and partner satisfaction
- No hormonal effect
- Economic adaptability of the treatment
- Possibility of associating any of the other treatments, further improving the possibilities of mucosal recovery and prolonging its action.
Laser treatment sessions are performed in a short period of time, a few minutes, and do not require analgesia or anesthesia as they are very well tolerated. They do not require subsequent rest, so the woman can go about her normal life after each session.
We consider it necessary to inform women who are in peri-postmenopause and who present vulvo-vaginal atrophy. It is necessary to explain, define and make these women aware of the possibility of improving their quality of life and their relationship with their partner with a treatment that has a very affordable price for the good results it can offer. Involving the partner should be considered another target on which to focus this information.