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Genital atrophy rapid after discontinuing hormone therapy.(Gynecology)
WHITE SULPHUR SPRINGS, W.VA. -- Within just 6-12 months of discontinuing hormone therapy, more than 96% of postmenopausal women will show altered vaginal pH, a marker for tissue change and its associated genital atrophy, Murray Freedman, M.D., reported.
Only 10 of 300 women maintained a normal vaginal pH of 4.5 or less after discontinuing HT use, and seven of those women had elevated serum estradiol levels related to obesity-driven estrogen production, said Dr. Freedman, of the Medical College of Georgia. Augusta.
The rest of the women had both elevated vaginal pH and decreased serum estradiol. The most common clinical finding in the study was involution of the vulvar structures and a rapidly occurring introital stenosis, which correlated with frequent complaints of dyspareunia, he noted at the annual meeting of the South Atlantic Association of Obstetricians and Gynecologists.
Because the onset of genital atrophy is insidious and its measurement subjective, the number who experienced it was "hard to quantify," Dr. Freedman said in an interview. "There is no real measurement for it. But for many of these women, the stenosis became noticeable within 6-12 months."
Dr. Freedman's observations have led him to conclude that the dyspareunia many postmenopausal women experience has more to do with introital stenosis than with vaginal dryness. "The dryness was secondary to the stenosis and the involution of the distal vagina. Once you got past the introitus, the upper vagina was uncompromised."
His prospective observational study evaluated a total of 300 women who had discontinued hormone therapy after publication of the initial Women's Health Initiative results in July 2002. All women underwent a pelvic exam and had their vaginal pH tested within 12 months of therapy discontinuation (most within 6 months). Those women with a normal vaginal pH level (4.5 or below) had their serum estradiol level evaluated.
The vast majority of the women (290) had a pH level of more than 4.5. Only 10 maintained a normal vaginal pH. Three of those women had serum estradiol of less than 20 pcg/mL, consistent with postmenopausal status.
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Source: HighBeam Research, Genital atrophy rapid after discontinuing hormone therapy.(Gynecology)