Terri Foran, a seasoned sexual health physician with over 40 years in sexual and reproductive medicine, dives deep into vaginal atrophy and menopause. She discusses the safety of vaginal estrogen, even for women over 70, and navigates the complexities for breast cancer survivors. Topics include the importance of open communication about bodily changes, the efficacy of DHEA, and personalized care. Terri also addresses alternative therapies and the management of symptoms in cancer survivors, shedding light on a often-taboo topic.
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Vaginal Atrophy Symptom Spectrum
Vaginal atrophy symptoms range from dryness and irritation to sexual discomfort and urinary issues.
A thorough history and examination help identify the best treatment options for diverse symptoms.
volunteer_activism ADVICE
Long-Term Vaginal Estrogen Use
Women can safely use vaginal estrogen for as long as needed with regular review.
Start with nightly use for two weeks then twice or thrice weekly, adjusting based on response.
volunteer_activism ADVICE
Approach for Younger Women
For younger women with vaginal dryness, first rule out common causes like vulval dermatitis.
Use vaginal estrogen cautiously after examination and try non-hormonal approaches first if appropriate.
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Vaginal oestrogen is safe at any age, including over 70, with regular review
Use vaginal oestrogen cautiously in younger women; rule out other causes such like vulval dermatitis
In breast cancer survivors, vaginal oestrogen is off-label; prefer estriol and involve oncology
Vaginal DHEA (Intrarosa) is effective with minimal absorption; lacks long-term safety data; no washout needed when switching
The questions answered in this podcast are listed below. They were compiled by GPs and health professionals around Australia who attended Healthed’s face-to-face seminars.
What are the main symptoms for women with vaginal atrophy, and what is the general approach when a woman comes to talk about these symptoms?
How long can women use vaginal oestrogen for?
If you saw a woman over the age of 70, would you feel comfortable allowing her to continue using vaginal oestrogen?
Is it safe to use vaginal oestrogen in a younger woman who might be breastfeeding or taking the combined oral contraceptive pill and experiencing vaginal dryness or discomfort?
Do you need to take the same precautions for side effects as you would with systemic hormone therapy? For example, if there was a woman who was prone to venous thromboembolism (VTE), is it safe for her to use vaginal oestrogen?
Is there any role for vaginal oestrogen in reducing the frequency of recurrent genital herpes outbreaks?
Are there situations where you would use vaginal oestrogen in combination with a non-hormonal product for better results?
Thoughts on laser treatments, microneedling, or PRP for vaginal or vulval symptoms?
In women who present with urethral caruncles, is there a role for vaginal oestrogen as part of the treatment? How long would you try using vaginal oestrogen for that?
What about the doses of oestrogen when treating someone who's had breast cancer? What do we have to be mindful of?
What about women with a history of endometrial, cervical, or vulval cancer? Can we use vaginal oestrogen if they've got symptoms?
Can DHEA (Intrarosa) be used safely in women with a history of cancer?
For women without breast cancer, when would you use DHEA instead of oestrogen?
Would you ever use both oestrogen and DHEA together?
What about using DHEA in conjunction with systemic menopausal hormone therapy?
Are there any thoughts around the improvements in libido with the use of DHEA?
If you had tried someone on Ovestin (estriol) and wanted to switch to Intrarosa, is a washout period required before starting?
Host: Dr Marita long | Total Time: 33 mins
Expert: Dr Terri Foran, Sexual Health Physician
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