The Doctor is in

Dr. Ricki Pollycove smiling

~ Ricki Pollycove, M.D.

Ricki Pollycove, M.D., M.S., is an OB/GYN in the field of integrative medical practice as well as individualization of menopause management. She has an active gynecology practice at the California Pacific Medical Center (CPMC) in San Francisco.

Dr. Pollycove has focused her career on healthy aging in women. She has a Bachelor's degree and Master of Science from the University of California (UC) Berkley, and completed her M.D. and residency at UC San Francisco. She is a board certified OB/GYN, specializing in the endocrinology of menopause, breast cancer and disease risk reduction as reflected in individual patient care options and clinical management and decision-making.

She has practiced at CPMC since 1981 as a member of the OB/GYN department, as well as academic and clinical teaching in the private community to professionals and the public alike. She currently serves as clinical faculty at UC School of Medicine in San Francisco and adjunct Integral Health Studies faculty at the California Institute of Integral Studies.

What? Women talk about what?

In my practice, the patients who talk about intercourse that is painful after menopause - bring it up in a lot of different ways. And yet, it’s rare to hear a woman use medical terminology to describe what she's experiencing. You don't need to feel bogged down by technicalities – that's your healthcare provider's job. Instead, it’s very important that every woman feels comfortable enough to explain what she’s feeling and experiencing as a result of menopause.

As an OB/GYN, I have heard it all – from the very tentative descriptions, to the downright graphic and detailed. And I can assure you that regardless of how a patient approaches this conversation or what language they choose to use, there's no wrong way to describe what you are experiencing! Here are a few examples of how my patients more often describe their concerns about moderate to severe painful intercourse due to menopause:

  • "I am worried because intercourse has gotten more painful."
  • "I don't feel comfortable talking about pain that I experience while having intercourse."
  • "I didn't expect to feel so much pain during intercourse after menopause. No one talked to me about this."

Do any of these sound familiar to you? Moderate to severe painful intercourse due to menopause is one of the most bothersome symptoms of a chronic and progressive medical condition called vulvar and vaginal atrophy (VVA), and it impacts many women in the U.S. – so if you're experiencing this, you are not alone!

Finding the right treatment option starts and ends with communication – you, the patient, being open with your healthcare provider about what you're going through. But also feel free to be open and honest with your partner and even your close trusted friends who can be helpful confidants. This is not something you need to or should deal with alone! Use whatever words and descriptors you feel most comfortable with and open up to your healthcare provider about it.

Surprising things you may not know about painful intercourse

What's the first thing you think of when you hear the word "menopause"? For many, it's probably "hot flashes," or something along those lines. Beyond that, not a whole lot is talked about – especially when it comes to intercourse.

When you go through menopause, your body undergoes many changes – including the rarely discussed physical changes of the vagina that can lead to vaginal aging, which may cause moderate to severe painful intercourse.

If you are like most women who visit my practice, the term "dyspareunia" (which means painful intercourse) is brand new to you – so you'll likely be surprised to learn that it's a condition impacting many postmenopausal women in the U.S.!

You may also be surprised to learn that:

  • Moderate to severe dyspareunia due to menopause is actually one of the most bothersome symptoms of a medical condition called vulvar and vaginal atrophy (VVA).
  • VVA is a real medical condition, and it is both chronic and progressive.
  • Many women who experience symptoms of dyspareunia due to menopause don't initiate a conversation with their healthcare provider about what they're experiencing. In fact, many don't talk to anyone about what they're experiencing – and unfortunately, a large percent remain undiagnosed and untreated.
  • Painful intercourse due to menopause can be managed with treatment – there is no reason for anyone to live with this condition in silence.

If you know or are concerned you may be experiencing symptoms of this condition, I'm here to tell you that you are not alone – and that you absolutely should not be living in silence. The first step toward getting help and, if appropriate, treatment, is talking with your healthcare provider about what you're experiencing – and they can work with you to figure out the best way to help you.

A variety of treatment options are available for moderate to severe dyspareunia due to menopause, including over-the-counter (OTC) lubricants and moisturizers, prescription estrogen hormone therapy and a non-estrogen oral option.

Having "the talk"

How's your relationship with your healthcare provider? Do you genuinely like him or her as a person and trust them with your wellbeing and health? Does your healthcare provider always make time to thoroughly address all of your concerns, including answering your last-minute questions – even it means running over the appointment by a few minutes?

No matter how great your healthcare provider-patient relationship is, I bet at some point you've had a check-up end without getting to ask certain questions or address concerns that are on your mind. Maybe you were in a rush and had to leave your appointment promptly, or maybe you weren't sure how to bring up what you wanted to discuss. I've encountered both situations with my patients, and know my colleagues have as well.

When it comes to talking about sensitive topics, like problems in the bedroom, I understand it can seem a little tricky – and I guarantee your healthcare provider understands this, too. We do our best to ask the right questions of our patients in hopes it'll get them to open up – particularly about something they were perhaps reluctant to bring up themselves. Sometimes just asking a quick "how's intercourse with your partner?" is enough to get a patient talking, but I've also had patients answer with the standard "fine," which may signal the end of the conversation – even though what they really meant was "fine, but it's not really fine."

That's why it can be very helpful – and empowering for yourself – to meet your healthcare provider halfway and start the conversation you know you need to have. Take it into your own hands. Speaking up with a simple "Is it normal for intercourse to be painful after menopause?" is a great opening line. So is "Intercourse has gotten very painful since I hit menopause and I want to know why, and if there's anything I can do about it."

If you're nervous about bringing up this topic or afraid that you'll just end up keeping your mouth shut when you're in the exam room, try writing your questions down on a piece of paper beforehand and bring it with you to the appointment. You don't even have to make eye contact, if that feels too vulnerable.

The important thing is that you speak up – however it feels comfortable to do so. Helping start the conversation (and advocating for yourself) will enable you to get the care you deserve!

MENOPAUSE: WHAT TO EXPECT

I like to remind my patients (and myself!) that you only continue to get more fabulous as you age. It's your wiser years - your 50s, 60s, and beyond - when you finally have the time to start thinking more about yourself and creating better balance. This is the time to take advantage of the life changes that have left you with some additional time on your hands - whether because your children have gone off to college, or you've cut back on hours at the office.

However, the changes that come as we age extend beyond those in our daily activities and social lives - they occur inside our bodies as well. On average, women begin to experience symptoms of menopause in their early to mid-50s, including the cessation of menstruation. Menopause is most frequently marked by the stopping of a woman's menstrual cycle, and confirmed by 12 consecutive months without menstruating. Just like getting your period, menopause is a completely normal part of every woman's life. But just because it is inevitable, it doesn't mean you can't be prepared!

While each woman experiences menopause differently, many women experience moderate to severe painful intercourse, one of the most bothersome symptoms of a condition called vulvar and vaginal atrophy (VVA), due to menopause. As a woman ages, a decline in estrogen changes the vaginal tissue - superficial cells decrease, parabasal cells increase - and vaginal pH also increases. These are what I call "unwelcome" changes to the vaginal tissue and can lead to moderate to severe painful intercourse due to menopause. What you may not realize is this can be treated, but you can only get help by speaking with your healthcare provider, describe what you're experiencing and then learn what options are available.

You may experience some or none of these changes - every woman is different. Some of my patients are surprised to learn that these changes I've described are biological changes caused by menopause - many of them believed they somehow caused these vaginal problems themselves! The most important thing to do is talk to your healthcare provider about what you are experiencing. Don't wait until your next annual checkup - if something is concerning you, or even if you just have a question, reach out to your healthcare provider to get more information. He or she is here to help you be your healthiest self at any age.

~ Ricki Pollycove, M.D.

Tips For a Healthy Lifestyle

Taking care of your health doesn't just mean speaking up when something's wrong. It's also about making your overall health a priority and proactively taking steps to stay strong and vital through proper diet and exercise.

As a healthcare provider, I've seen many women take care of those they love first, but it's just as important to take care of yourself! You may already be following some or all of the tips I've listed below, but it never hurts to pause a moment to remind yourself that there is never a wrong time to start living more healthfully.

"Baby steps to better health" is how I like to break this down. By starting small and having some success with doing what we know is better for us, we can then add another positive change. Here are some of the suggestions I recommend to my patients who are looking for some tips:

Get moving. I'm a firm believer that physical activity that gets your heart pounding and your body moving is important for looking and feeling better. Nothing beats that natural endorphin rush that you get after a great workout. And exercise doesn't have to — and shouldn't — feel like another chore. Try out different things and see what you actually enjoy doing; if you like it, you'll be more likely to stick with it. You can even find "sneaky" ways to get some exercise in — try doing some "bicycles" lying on your back, or crunches and push-ups when you're watching TV. Or try doing some simple leg-lifts when pumping gas — I like to do that, because it makes the time to take care of the car time to take care of me, too! And remember, it's okay to take it slow — it doesn't have to be all or nothing. Think of it as "you" time. Any amount of time you can manage to get your heart rate up and muscles burning will do your body good!

Don't skimp on sleep. Too many women sleep less than the recommended eight hours a night which can be harmful to overall health, energy and mentality. If you've been burning the candle at both ends, try committing to getting at least seven hours of sleep for a solid week and then see how you feel. Studies also show that women who sleep more may weigh less, so take advantage!

If you smoke, quit. Personally, I believe this one's a no brainer. Consider yourself a step ahead of the game if you've never been a smoker or you've already kicked the habit. And if you do smoke, it's nothing to be ashamed of — and it is important to know it's never too late to quit. Often I remind my patients that "to be a healthy self" is always an uphill battle. It is important to face the fact that cigarettes are biologically and chemically addicting so your body often doesn't want to quit — it is up to you! But know that giving up smoking is one of the best decisions you can make for your body.

Eat well. When you consistently eat foods that are good for you (and that taste good too!), you're fueling and nourishing your body with a purpose. I'm also of the belief that we deserve to, and should, indulge every so often in our favorite treats — life is too short to deny yourself completely! It's just about balance, and you'll probably find that the more you eat foods like fresh fruits and vegetables, whole grains and lean proteins, you'll be more inclined you'll be to keep eating that way. Take a pause before you start eating; this "mindful moment" may help you focus more on what you are putting into your body — and help you avoid automatically gobbling down the butter-laden mashed potatoes!

Of course, as with anything health-related, it's important to talk to your healthcare provider about any changes you're making to your diet or exercise routine — it is good to get their "stamp of approval" and encouragement!

Available Treatment Options

With both over-the-counter (OTC) and prescription options available for the treatment of painful intercourse due to menopause, how do you know which is right for you? Researching options on your own can be a good starting place for your foundation of knowledge, but there's a lot to know — and it can seem confusing or overwhelming.

Ultimately, your healthcare provider is the best and most appropriate resource to guide you in the direction you need based on your symptoms, medical history and other personal details.

When my patients hear about a treatment option for a condition they think or know they're experiencing, they'll often come to me with questions about it. And part of what ultimately will help me examine and decide what course of treatment is best for any patient, is that I ask questions specific to what they've been experiencing.

To help ensure your discussion with your healthcare provider about painful intercourse due to menopause is as productive as possible, here are some starter questions for you to consider in advance:

  • When did your vaginal pain due to menopause start?
  • How intense is your vaginal pain due to menopause? Is it moderate to severe?
  • Have you ever tried using lubricants or prescription medications?

In my experience, when my patients are prepared to answer and discuss these questions with me, I'm able to more easily assess their unique needs.

This also applies to any health issue you might be dealing with — it's always important to be open and honest with your healthcare provider about what you're experiencing and any other concerns you might have. It's also equally as important to become as informed as possible with what treatment options are available, so you can work closely with your healthcare provider and decide what's best for you.

No matter what you do, don't keep the problem to yourself.

learnmore

Learn more about a prescription treatment option for moderate to severe painful intercourse due to menopause.

Learn More
In Virginia'swords

Virginia Madsen shares her personal tips to help you break the silence.

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What is Osphena™ (ospemifene) tablets?

Osphena is a prescription oral pill that treats painful intercourse, a symptom of changes in and around your vagina, due to menopause.

Important Safety Information For Osphena™

Most Important Information you should know about Osphena

Osphena works like estrogen in the lining of the uterus, but can work differently in other parts of the body.

Taking estrogen alone or Osphena may increase your chance for getting cancer of the lining of the uterus, strokes, and blood clots. Vaginal bleeding after menopause may be a warning sign of cancer of the lining of the uterus. Your healthcare provider should check any unusual vaginal bleeding to find out the cause, so tell them right away if this happens while you are using Osphena.

You and your healthcare provider should talk regularly about whether you still need treatment with Osphena.

Call your healthcare provider right away if you get changes in vision or speech, sudden new severe headaches, and severe pains in your chest or legs with or without shortness of breath, weakness and fatigue.

Osphena should not be used if you have unusual vaginal bleeding; have or have had certain types of cancers (including cancer of the breast or uterus); have or had blood clots; had a stroke or heart attack; have severe liver problems; or think you may be pregnant. Tell your healthcare provider if you are going to have surgery or will be on bed rest.

Possible side effects of Osphena

Serious but less common side effects can include stroke, blood clots, and cancer of the lining of the uterus.

Common side effects can include hot flashes, vaginal discharge, muscle spasms and increased sweating.

Tell your healthcare provider about all of the medicines you take as some medicines may affect how Osphena works. Osphena may also affect how other medicines work.

Please read accompanying Patient Information for Osphena™ (ospemifene) tablets, including Boxed WARNING in the Full Prescribing Information

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