How you can help patients going through menopause

This Friday (October 18) is World Menopause Day. To mark this Fiona Vlemmiks explores one of the genitourinary disorders, a distressing but often less discussed part of the menopause and how you can help patients.

Thanks to the media, public awareness of issues relating to menopause has risen in recent years, yet many women are still too embarrassed to discuss some of the symptoms – especially those that relate to the genital area. 

According to NICE, about 80% of women in the UK experience the effects of the menopause and one in four have severe symptoms, including anxiety and depression, which can lead to them being diagnosed with mental health problems. 

The Genitourinary Syndrome of Menopause (GSM), which is a fairly new term, refers to changes in the vagina, vulva and bladder, brought about by the decrease in oestrogen during and after menopause. Signs and symptoms may include vaginal dryness, burning and discharge, decreased vaginal lubrication during sexual activity, and a shortening and tightening of the vaginal canal. This can be coupled with genital itching, recurrent urinary infections and an increased urgency to urinate. According to the International Society for Sexual Medicine (ISSM), GSM affects around half of menopausal and post-menopausal women. 

Dr Rekha Tailor is the founder and medical director of Health & Aesthetics in Elstead, Surrey. She treats many menopausal women. “The vaginal skin has receptors for oestrogen. Oestrogen increases secretions and therefore after the menopause these secretions decrease leading to dryness”, she says.

“Gynecologists call this vaginal atrophy. In addition to the other complications, atrophy also causes fragility of the skin and this can cause bleeding. 

“Any bleeding after the menopause is always taken seriously as there could be underlying cervical or uterine cancer. However, the commonest cause of bleeding in the menopause, in more than 80% of women, is vaginal atrophy. 

“The front of the vagina is very close to the base of the bladder and weakness of the vaginal skin causes extreme irritability of the bladder, which is sometimes called urethral syndrome. With this, women complain of increased urinary frequency, urgency and having to wake up at night.” 

In addition to the discomfort caused by GSM, which can in itself cause women to struggle with day-to-day activities, the issue can have a massive emotional impact, leading to loss of confidence and even anxiety and depression. Furthermore, in 2016, a British Menopause Society (BMS) survey revealed that half of the women surveyed admitted that the menopause had put a strain on their sex life. 

Doctor Nadia Yousri is a obstetrician and gynaecologist who specialises in fertility, sexual wellness, non-surgical gynaecology and regenerative medicine. She says:“GSM symptoms can be some of the worst symptoms of the menopause because of the implications on sexual relationships and on quality of life. Women experience a loss of confidence and don’t feel feminine anymore and it can lead to marital problems.” 

Although the media is now focused on publicising women’s health issues, Dr Shirin Lakhani, founder of Elite Aesthetics in Kent, believes there’s more to be done.

Dr Lakhani has much expertise in the area of intimate rejuvenation and is a strong advocate of women’s health and comprehensive menopausal care. 

“Until recently people wouldn’t talk the menopause and some women are still too embarrassed to talk about it,” she says. “Luckily we’ve had some high profile celebrities come out and speak about the menopause, which is making women more aware of the options available to them. Other countries are well ahead of the UK when it comes to menopause management.

“I have had women tell me that they’ve spoken to their GP about the menopause and they’ve just told them to ‘get on with it’. However, when it comes to GSM, there are a range of treatments available. It’s just that people don’t know about them and that’s why educating people has been a huge part of my press strategy recently. When I hear what people go through, I get quite cross because they are not getting the care they need. There is plenty that can be done and treatment can be tailored to the individual.” 

TREATMENT LOW DOWN 

Lubricants and vaginal oestrogen 

For less severe symptoms lubricants and vaginal moisturiser in gel or liquid form can temporarily, but immediately, ease discomfort or pain during sex or even outside of sexual activity.

However, this type of treatment doesn’t restore the vaginal physiology and many women find the lubricants messy or a turn-off during intimate activity.

Prescription vaginal oestrogen in the form of cream or a pessary is also an effective but temporary solution, as problems will return once product use has ceased.

Side effects can also include irritation and damage to latex condoms and diaphragms.

“For it to be effective, this treatment would need to be maintained indefinitely with vaginal application about twice weekly,” says Dr Tailor. “Some women are reluctant to use this, especially those with a history of breast cancer, although concerns are generally not well founded as studies have shown that vaginal oestrogens can be used safely in a large proportion of these women.” 

Laser and high frequency

Vaginal rejuvenation via laser offers a non-surgical, quick and safe solution for various common feminine issues, such as stress urinary incontinence (SUI), vaginal laxity, vaginal dryness and recurring infections, caused by menopause and other hormone deficiency.

Dr Rekha Tailor has been offering FemiLift treatments from Alma Lasers (ABC Lasers) to patients for more than four years at her clinic and has received great feedback from patients, many of whom describe the treatment as “life-changing”.

FemiLift uses a CO2 laser to heat the tissue in the vaginal walls. “Laser treatments improve the tissue quality by stimulating collagen production. This increase in collagen rejuvenates and tightens vaginal tissue, which in turn improves vaginal dryness”, Dr Tailor explains.

The treatment takes between 10 and 15 minutes and doesn’t require any downtime. 

“FemiLift is a great long-term solution for vaginal dryness, as well as many other problems women might experience such as a weak pelvic floor, painful sex and urinary incontinence,” she says. 

PRP rejuventation 

Another non-hormone treatment for menopause symptoms such as vaginal dryness is PRP, which uses the body’s own platelet rich plasma (PRP) to rejuvenate and stimulate the vagina, just like it does on the face. Dr Lakini uses the O Shot PRP treatment. “I find this works in the majority of patients suffering from vaginal atrophy,” she says, “It’s a good treatment because it stimulates the skin’s glands and provides natural lubricant.”

The O-Shot works by taking a small amount of blood from the patient, placing it in a centrifuge to separate and concentrate the PRP, before injecting it into specific areas in the clitoris, labia and vagina. 

The PRP then stimulates the omnipotent stem cells (cells that are capable of developing into any type of tissue), leading to an increase in the speed of cell growth and tissue regeneration. This can improve lubrication, sensitivity, and is an effective treatment for stress incontinence and other symptoms of GSM.

Fillers

Hyaluronic acid (HA) is naturally present in the vaginal mucosa and injecting it into the vestibular and vaginal mucous membrane can provide a solution for problems related to dryness of the vulva and vagina, especially for women who want to avoid oestrogen or other hormonal products. Vivacy’s DESIRIAL product is the only injectable HA that has been CE marked for gynaecological indications.

Dr Yousri has been using Vivacy’s DESIRIAL on patients for two years with huge success. She says: “With menopause, many women experience shrinkage of the vaginal tissues, resulting in loss of the volume of the outer labia and the cushion-like protection this offers. Injecting HA can hydrate and soothe irritated areas and the tone and tension of the connective tissues are also restored. It can help women suffering from volume loss of the vulvar labia majora as it strengthens the protective role of the labia majora and improves the aesthetic appearance of the vulvo-vaginal area. 

“DESIRIAL contains mannitol, which is hygroscopic and an antioxidant, so it slows down the breakage of the HA and prolongs the duration of action. Results are immediate and can last for up to a year. The treatment is changing women’s lives, meaning they no longer suffer in silence which is why I am a strong advocate,” adds Dr Yousri. 

 

 

 

This Friday (October 18) is World Menopause Day. To mark this Fiona Vlemmiks explores one of the genitourinary disorders, a distressing but often less discussed part of the menopause and how you can help patients.

Thanks to the media, public awareness of issues relating to menopause has risen in recent years, yet many women are still too embarrassed to discuss some of the symptoms – especially those that relate to the genital area. 

According to NICE, about 80% of women in the UK experience the effects of the menopause and one in four have severe symptoms, including anxiety and depression, which can lead to them being diagnosed with mental health problems. 

The Genitourinary Syndrome of Menopause (GSM), which is a fairly new term, refers to changes in the vagina, vulva and bladder, brought about by the decrease in oestrogen during and after menopause. Signs and symptoms may include vaginal dryness, burning and discharge, decreased vaginal lubrication during sexual activity, and a shortening and tightening of the vaginal canal. This can be coupled with genital itching, recurrent urinary infections and an increased urgency to urinate. According to the International Society for Sexual Medicine (ISSM), GSM affects around half of menopausal and post-menopausal women. 

Dr Rekha Tailor is the founder and medical director of Health & Aesthetics in Elstead, Surrey. She treats many menopausal women. “The vaginal skin has receptors for oestrogen. Oestrogen increases secretions and therefore after the menopause these secretions decrease leading to dryness”, she says.

“Gynecologists call this vaginal atrophy. In addition to the other complications, atrophy also causes fragility of the skin and this can cause bleeding. 

“Any bleeding after the menopause is always taken seriously as there could be underlying cervical or uterine cancer. However, the commonest cause of bleeding in the menopause, in more than 80% of women, is vaginal atrophy. 

“The front of the vagina is very close to the base of the bladder and weakness of the vaginal skin causes extreme irritability of the bladder, which is sometimes called urethral syndrome. With this, women complain of increased urinary frequency, urgency and having to wake up at night.” 

In addition to the discomfort caused by GSM, which can in itself cause women to struggle with day-to-day activities, the issue can have a massive emotional impact, leading to loss of confidence and even anxiety and depression. Furthermore, in 2016, a British Menopause Society (BMS) survey revealed that half of the women surveyed admitted that the menopause had put a strain on their sex life. 

Doctor Nadia Yousri is a obstetrician and gynaecologist who specialises in fertility, sexual wellness, non-surgical gynaecology and regenerative medicine. She says:“GSM symptoms can be some of the worst symptoms of the menopause because of the implications on sexual relationships and on quality of life. Women experience a loss of confidence and don’t feel feminine anymore and it can lead to marital problems.” 

Although the media is now focused on publicising women’s health issues, Dr Shirin Lakhani, founder of Elite Aesthetics in Kent, believes there’s more to be done.

Dr Lakhani has much expertise in the area of intimate rejuvenation and is a strong advocate of women’s health and comprehensive menopausal care. 

“Until recently people wouldn’t talk the menopause and some women are still too embarrassed to talk about it,” she says. “Luckily we’ve had some high profile celebrities come out and speak about the menopause, which is making women more aware of the options available to them. Other countries are well ahead of the UK when it comes to menopause management.

“I have had women tell me that they’ve spoken to their GP about the menopause and they’ve just told them to ‘get on with it’. However, when it comes to GSM, there are a range of treatments available. It’s just that people don’t know about them and that’s why educating people has been a huge part of my press strategy recently. When I hear what people go through, I get quite cross because they are not getting the care they need. There is plenty that can be done and treatment can be tailored to the individual.” 

TREATMENT LOW DOWN 

Lubricants and vaginal oestrogen 

For less severe symptoms lubricants and vaginal moisturiser in gel or liquid form can temporarily, but immediately, ease discomfort or pain during sex or even outside of sexual activity.

However, this type of treatment doesn’t restore the vaginal physiology and many women find the lubricants messy or a turn-off during intimate activity.

Prescription vaginal oestrogen in the form of cream or a pessary is also an effective but temporary solution, as problems will return once product use has ceased.

Side effects can also include irritation and damage to latex condoms and diaphragms.

“For it to be effective, this treatment would need to be maintained indefinitely with vaginal application about twice weekly,” says Dr Tailor. “Some women are reluctant to use this, especially those with a history of breast cancer, although concerns are generally not well founded as studies have shown that vaginal oestrogens can be used safely in a large proportion of these women.” 

Laser and high frequency

Vaginal rejuvenation via laser offers a non-surgical, quick and safe solution for various common feminine issues, such as stress urinary incontinence (SUI), vaginal laxity, vaginal dryness and recurring infections, caused by menopause and other hormone deficiency.

Dr Rekha Tailor has been offering FemiLift treatments from Alma Lasers (ABC Lasers) to patients for more than four years at her clinic and has received great feedback from patients, many of whom describe the treatment as “life-changing”.

FemiLift uses a CO2 laser to heat the tissue in the vaginal walls. “Laser treatments improve the tissue quality by stimulating collagen production. This increase in collagen rejuvenates and tightens vaginal tissue, which in turn improves vaginal dryness”, Dr Tailor explains.

The treatment takes between 10 and 15 minutes and doesn’t require any downtime. 

“FemiLift is a great long-term solution for vaginal dryness, as well as many other problems women might experience such as a weak pelvic floor, painful sex and urinary incontinence,” she says. 

PRP rejuventation 

Another non-hormone treatment for menopause symptoms such as vaginal dryness is PRP, which uses the body’s own platelet rich plasma (PRP) to rejuvenate and stimulate the vagina, just like it does on the face. Dr Lakini uses the O Shot PRP treatment. “I find this works in the majority of patients suffering from vaginal atrophy,” she says, “It’s a good treatment because it stimulates the skin’s glands and provides natural lubricant.”

The O-Shot works by taking a small amount of blood from the patient, placing it in a centrifuge to separate and concentrate the PRP, before injecting it into specific areas in the clitoris, labia and vagina. 

The PRP then stimulates the omnipotent stem cells (cells that are capable of developing into any type of tissue), leading to an increase in the speed of cell growth and tissue regeneration. This can improve lubrication, sensitivity, and is an effective treatment for stress incontinence and other symptoms of GSM.

Fillers

Hyaluronic acid (HA) is naturally present in the vaginal mucosa and injecting it into the vestibular and vaginal mucous membrane can provide a solution for problems related to dryness of the vulva and vagina, especially for women who want to avoid oestrogen or other hormonal products. Vivacy’s DESIRIAL product is the only injectable HA that has been CE marked for gynaecological indications.

Dr Yousri has been using Vivacy’s DESIRIAL on patients for two years with huge success. She says: “With menopause, many women experience shrinkage of the vaginal tissues, resulting in loss of the volume of the outer labia and the cushion-like protection this offers. Injecting HA can hydrate and soothe irritated areas and the tone and tension of the connective tissues are also restored. It can help women suffering from volume loss of the vulvar labia majora as it strengthens the protective role of the labia majora and improves the aesthetic appearance of the vulvo-vaginal area. 

“DESIRIAL contains mannitol, which is hygroscopic and an antioxidant, so it slows down the breakage of the HA and prolongs the duration of action. Results are immediate and can last for up to a year. The treatment is changing women’s lives, meaning they no longer suffer in silence which is why I am a strong advocate,” adds Dr Yousri.