Vaginal treatments no better than placebos after menopause: Study

New research has found that vaginal oestradiol tablets and over-the-counter vaginal moisturisers may not be much help when it comes to soothing menopause-related vulvovaginal symptoms.

The study by the Massachusetts General Hospital in America and published in the JAMA Internal Medicine Journal said that both prescribed oestradiol hormone tablets and an over-the-counter vaginal moisturiser were no better than placebos in reducing a range of postmenopausal vaginal symptoms.

Women can show a range of symptoms after menopause including dryness, itching, pain, as well as discomfort during and after sex.  Researcher Caroline Mitchell of Massachusetts General Hospital in Bostontold Starts at 60 that there were three strands in the trial she worked on into treatments for these symptoms.

“We had three arms in the trial: one with a 10mcg oestradiol vaginal tablet (Vagifem) and a placebo gel, one with an over-the-counter vaginal moisturiser (Replens) and a placebo tablet, and one with both placebos,” she said. The researchers wanted to test whether he prescribed tablet and the over-the-counter cream were effective.

Mitchell said that while the trial of 302 women saw a 50 per cent decrease of symptom severity, that happened in all three arms of the trial – even with the women who weren’t actually using any medication, but were given a placebo instead

“Neither ‘active’ treatment worked better than placebo,” she said. “It is possible that our placebo gel had some beneficial effect. That said, only 50 per cent of women had more than 50 per cent decrease in symptom severity – this suggests that things could be better.”

Mitchell said that the medical fraternity still didn’t fully understand the causes of menopause-related vulvovaginal conditions, because all women suffered a drop in oestrogen at menopause but only half developed vaginal discomfort as a result.

She added that a greater scientific understanding could result in better-targeted therapies that could be more effective, pointing out that the trial collected biologic samples to help researchers understand the factors that contribute to postmenopausal vaginal discomfort.

And while symptoms such as dryness, itching and pain are common post-menopause, Mitchell advised women not to brush them off as normal, but to consult their doctor.

“First, get an evaluation to be sure that there is nothing else going on,” she said. “Second, our data suggests that using something regularly may provide benefit. No single treatment is ideal for everyone – some people don’t mind vaginal gels, others don’t like them.”

She said that using cheap moisturisers and vaginal lubricants are a good place to start and when used three times a week could provide benefit.

“These types of symptoms can cause significant distress, and many women do not know how common they are – up to 50 per cent of women have vaginal discomfort after menopause,” she said. “This is not just something that one has to live with – there are strategies to treat these symptoms. Women should reach out to their health care provider.”

What do you think? How do you best treat your symptoms?