Vulvovaginal health for women in menopause, athletes included

TRIGGER WARNING: I’m going to talk about topics that some may find uncomfortable. Namely, I’m going to discuss female genital health.

Buckle your seat belts, things are about to get personal. 

I already tend to be personal in these blog posts, and along those lines I’m going to address an issue that has come up for me, due to taking the aromatase inhibitor drug letrozole and having zero estrogen in this body of mine. I’ve now been on letrozole for 6 months. That’s enough time to get rid of every drop of estrogen. 

I never knew how much I valued the small amount of estrogen this post-menopausal body had going on in it before letrozole.  

I noticed immediately terrible aches and pains in my joints, bones and muscles. Additionally, I started needing almost daily naps. Thankfully short naps revive me enough to keep working and making it through the day without full collapse. I also started having a harder time sleeping through the night, largely due to the awful hot flashes that started with a vengeance. I thought I had made it through the hot flash stage of menopause. Turns out zero estrogen cranks up the hot flash dial.

Thankfully, the weekly acupuncture sessions and the Chinese herbs my wonderful acupuncturist John Falls, at The Penny George Institute for Health and Healing, suggested I take (based on my constitution) both really help me navigate these particular challenges. 

Another terrible side effect of no estrogen is even drier skin everywhere on my body. Diabetes contributes to dry skin, remove estrogen and it’s even worse. I didn’t want to use over the counter lotion any more due to harmful ingredients. I started making homemade body lotion from organic beeswax mixed with organic coconut oil at a ratio of 1 tablespoon of beeswax to 7 tablespoons of coconut oil. This homemade lotion works great. If you try it, let me know what you think.  

The one side effect of zero estrogen that never really got mentioned directly anywhere, turns out it’s actually a prevalent condition for up to 90% of women at the menopause stage of life. I wasn’t having a terrible case of this side-effect, but I suspected I was easing up to it. Are you curious yet? Maybe based on the title of this blog, you know what I’m about to discuss. 

I was listening to a podcast called Hit Play Not Pause put on by mountain biker and women’s wellness writer extraordinaire Selene Yeager of Feisty Media and Feisty Menopause. 

I was listening to an episode where Selene interviews gynecologist Rochelle Bernstein, MD who has a practice in Denver, Colorado, where many of the women she sees in her practice are endurance athletes. On that alone, I was very interested!

They started talking about GSM, which is genitourinary syndrome of menopause. 

To quote Dr. Bernstein, “Unlike some menopause symptoms that may diminish with time, GSM symptoms such as vaginal dryness, thinning, pain, and irritation tend to persist and even worsen as we age due to the physical alterations in the tissues.

The decline in estrogen levels during menopause plays a pivotal role in these transformations. Estrogen is essential for maintaining pelvic blood flow, vaginal tissue thickness, elasticity, and moisture, as well as the resilience of vulvar tissues. Without an adequate supply of estrogen, the tissues become thinner, drier, less elastic, and more susceptible to damage, resulting in discomfort during daily activities and sexual intercourse. Furthermore, estrogen deficiency can contribute to urinary issues like incontinence and urinary tract infections, along with other conditions.”

OMG. 

This freaked me out. I could tell no estrogen was having an impact on my body, but having vaginal pain and thinning vaginal walls and tissue, NO WAY. I love, love, love biking and having extreme pain in my genital parts while biking is NOT something I want to happen.

Plus, I’m working on coming out of my nun-phase. I’ve spent the past 10-12 years doing lots of intensive self analysis and much good healing on my patterns and soul. I’m working up to begin meeting men (first step!) and to start dating for continued learning and more fun. Eventually, I’d like to have sex again. Painful sex, no thank you. 

I listened to the podcast twice. 

Then I went to Dr. Bernstein’s website and read more. I even went to her Products page and looked at everything she suggested. Yes, I purchased a MysteryVibe Poco Vibrator, which is a product Dr. Bernstein recommends. Take a deep breath, I did mention this post was going to be revealing and personal. 

I have noticed that my sex drive has diminished with lower estrogen over the years, and in the past 6 months my sex drive is practically zero. Not really a surprise given worrying about cancer for a third time, and my diminished energy, plus no boyfriend or partner! But heck, if I want to get back in the dating game and eventually back into having sex, I want to at least remember what feeling sexual feels like in this body. Having a good vibrator is simply a good plan. 

Dr. Bernstein says this on her website, “Without controversy, vaginal estrogen is the gold standard for treatment of GSM. Estrogen applied to the vagina via creams, tablets, inserts, and rings have significant effect on surrounding tissues but do not raise the overall (systemic) amount of estrogen above a typical menopausal level. The use of vaginal estrogen in women who have had estrogen-sensitive cancers remains controversial since research on the risk is not conclusive to date.”

Thus, my next step was to bring this up with my oncologist. I asked her about this at my visit with her in February. She responded immediately by giving me a prescription for Estradiol Vaginal Cream, USP. Thankfully my insurance covered it with only a minimal copay. I take 2mg of the cream twice a week. She said that the quality of my life, including my (potential) sex life, matters and that new evidence says that taking vaginal estradiol cream does not seem to impact estrogen receptor positive breast cancer, which I have, for the third time. 

If you don’t want to use estadiol vaginal cream, please read Dr. Bernstein’s essay about GSM with care. She offers other ideas for things to do to help keep your vaginal tissues in good condition. Turns out, taking care of these these precious tissues is worth the effort.

It’s better to prevent or treat early the symptoms of GSM, before the tissues thin and become too fragile. I am willing to take action! And I have. So far so good. Taking estradiol hasn’t improved my sex drive, but if nothing else, I’m aware of keeping my genitals in tip top shape. That helps keep sex on my mind, which helps. If nothing else, it makes me laugh. AND it gives me something to talk about when I’m out running with friends.

My intention in writing this blog, is to be part of helping menopausal women, which is ALL women, who have breast cancer or not, talk about genital health. We are worth it. It’s important to share this information and discuss strategies together. Please share this blog if you found it helpful. Let’s collectively get the word out and let’s talk about our genital health.

Please, take a listen to the podcast and/or take a look at Dr. Bernstein’s website. Become informed. Talk about this with your friends. Really. Be brave. 

And men, you too, please read about this. Ask about it. Inform yourself. You have women in your life. Friends, wives, girlfriends, daughters, sisters, mothers, aunts. Even if you are someone who sleeps with other men, you still know women. It’s worth being informed!

Thanks for reading! Let me know your reaction to all I’ve brought up here. I confess, it’s a risk being this vulnerable. I’ve had to take a lot of deep breaths and find my courage. You are worth it. And I am worth it. Collectively we are worth it.

With love,

Mari