Does sex decrease vaginal dryness?
Answering your questions about hormone therapy and blood clots, PMS in your 40s, and a new study about vaginal dryness and sex
Time for a Q&A to answer your questions about:
· How to treat perimenopausal symptoms when you have had a blood clot
· Why PMS gets worse in your 40s
· A new study that found an association between sex and reduced vaginal dryness
Enjoy! And remember to e-mail your questions to gillian@thesavvypatient.com or leave them in the chat
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Q: I had a blood clot in my leg in my mid-20s, after I had been on the pill (Yaz) for about two years. I had genetic testing at that time and came up negative for clotting disorders, but will my personal history of having had a blood clot while on the pill disqualify me from receiving hormone replacement therapy in the future? I’m currently 40. —Hormones Please
A: This is one of the very few times we don’t recommend taking estrogen. Estrogen circulating systemically can increase the risk for having another clot. But that doesn’t mean you are out of luck. You have lots of options for treating any menopause symptoms you develop in the coming years.
First of all, while systemic estrogen (estrogen as a pill taken by mouth, a patch, or gel) isn’t safe for you, vaginal estrogen prescribed to treat vaginal dryness and vulvovaginal atrophy is safe for nearly all women. It has not been shown to cause blood clots. As a result, it’s the best option if you develop these types of symptoms. Progesterone is also safe for women with a history of blood clots, and while it isn’t as helpful as estrogen for hot flushes and night sweats, it can help with sleep.
Second, there are effective nonhormonal medications for treating perimenopausal symptoms. Fezolinetant (Veozah) has been shown to significantly reduce hot flushes and night sweats. A similar drug, elinzanetant, reduces hot flashes and night sweats, but may also help with mood and sleep. It should be approved later this year.
The Savvy Short: Women with a history of blood clots should not take systemic estrogen, but they still have many options for treating perimenopausal symptoms.
Q: I am 43 years old and just had my second baby five months ago. I’ve noticed since my period came back that I’m having more PMS symptoms (bloating, cramps, major cravings, migraines) leading up to and during ovulation before my period. Am I making this up or does this happen to some women? Does it have anything to do with age-related hormonal shifts or perimenopause? —Anne
A: Congratulations on the new baby! And no, you aren’t making this up. Menstrual periods and the symptoms that come along with them do change over time. And your early 40s are a common time to see some of these changes sneak in. In fact, about 41% of women will see period changes between the ages of 40 and 44 and another 27% will see period changes between the ages of 35 and 39.
Common changes include periods that are heavier or lighters and periods that are more closely spaced as well as a dialing up of PMS symptoms, in particular mood changes. This is all part of the late-reproductive stage. This is the stage in your reproductive life between your peak reproductive years and perimenopause. Basically, it is taking more stimulation from your pituitary gland to get your eggs to ovulate, but that increased stimulation also causes estrogen to rise higher and drop lower over the course of your menstrual cycle. It is the drop in estrogen levels before your periods that causes more severe PMS.
What distinguishes the late-reproductive stage from perimenopause is regular periods. In the late reproductive stage menstrual periods are roughly the same length from the first day of one period to the first day of the next. In perimenopause, the menstrual cycle length varies by more than 7 days from the first day of one period to the first day of the next. Essentially, the frequency becomes irregular.
Being in the late reproductive stage doesn’t mean menopause is especially close. Most women enter the late-reproductive stage between the ages of 35 and 45, but the average age of menopause is 52. So, you likely have at least a decade to go!
The Savvy Short: It is very common for women to see period changes between the ages of 35 and 45, including worsening PMS, before they officially enter perimenopause.
Q: I heard about a study recently that said that sex was a good way to treat vaginal dryness and genitourinary syndrome of menopause. Does the data really support this or is this just clickbait? —Anonymous
A: I saw some of the reports you’re referring to. Of course, I had to read the study they were based on, which was recently published in Menopause. The new paper was part of a larger Japanese study of genitourinary symptoms of menopause (GSM), the name we give to the constellation of symptoms that can develop in perimenopause or menopause and includes vaginal dryness, vulvovaginal atrophy, and urinary symptoms.
The authors took a subset of 911 study participants and sorted them into two groups—women who had participated in sex in the last three months and women who had participated in sex in the last year but not in the last three months. They gave all the women a survey about GSM. Then they looked for differences between the two groups.
The researchers found that the women who had sex more recently reported less vaginal dryness, though not necessarily any reductions in other GSM symptoms. They note the association, but don’t suggest the relationship is causal. I would question if the relationship might be causal, but not in the direction that some reports suggested. I suspect that women who have less vaginal dryness find sex more enjoyable and so they have sex more often. But that is pure speculation on my part. All the data really says is that there is an association.
The Savvy Short: A recent study found that having sex more recently was associated with less vaginal dryness, but the study did not show that having sex decreased vaginal dryness.