Some of the most common experiences of menopause are the changes that occur on the external genital tissue and intravaginal tissue that can then also affect urinary function. This is called genitourinary atrophy, and now coined, genitourinary syndrome of menopause (GSM). Symptoms can include one or more of the following: vulvovaginal discomfort, itching, burning, tingling, dryness, thinning of tissue, pain, pain with vaginal penetration related to dryness and/or tightness of vaginal opening, post coital bleeding, vaginal discharge, bladder leakage, and urinary incontinence. These symptoms can affect comfort and quality of life with up to 40% of menopausal women being affected in their sex life, 17% their confidence, 13% their partner relationship, and 7% their social life.
There are many options to address these genitourinary atrophic changes and symptoms, the most studied and effective is vulvovaginal estrogen, which can be used with safety and effectiveness. There are some nuances to that statement in women with a history of breast cancer. None the less, some women seek other options, including over-the-counter lubricants, over-the-counter moisturizers, and herbal/nutrient agents. One such item that has been subject to a small amount of research is vitamin E suppositories.
The study I refer to here compared vitamin E 100 IU suppositories to vaginal estrogen cream in 52 menopausal women with symptoms of vulvovaginal atrophy and a vaginal pH above 5.0. Laboratory studies included the assessment of the vaginal maturation value (VMV), and Menopause-Specific-Quality of Life (MENQOL) questionnaire. Participants in the study were given 12 weeks of either vitamin E vaginal suppository or conjugated estrogen vaginal cream, 0.625 mg (0.5 gm is equivalent to 1.8 gm of the cream in the applicator). They were instructed to insert the item nightly for the first two weeks and then twice per week for the next 10 weeks.
Results: Results showed that quality of life scores were not significantly different in the two groups after 4, 8 and 12 weeks of treatment.
Commentary: While the vitamin E suppository working basically as well as the vaginal estrogen product sounds positive, there were no specifics comparing burning, dryness, pain, itching, or urinary incontinence, but rather physical symptoms were lumped together as one of the overall four categories of quality-of-life assessment: vasomotor symptoms (hot flashes/night sweats), psychosocial, physical, and sexual. From my understanding of the tables, the physical symptoms did score about 20 points better in the vaginal estrogen group than the vitamin E group.
What do I think??? I think vaginal estrogen is completely safe with this kind of regimen… nightly for 2 weeks then twice weekly maintenance. Even for breast cancer survivors, vaginal estrogen in the form of tablets, a ring, or a suppository, is not associated with a meaningful or lingering elevation in
blood levels of estrogen, whereas cream raises blood levels more, and is usually avoided in breast cancer patients. For women with a history of uterine or ovarian cancer, the published research would support the use of vaginal estrogen tablets/suppositories and a local dosing of a vaginal estrogen ring (ex/ ESTRING), as safe. Even the American College of Gynecologists and the Menopause Society guidelines state that moisturizers and lubricants are first-line recommendations for breast cancer patients, but if those are inadequate, then low-dose vulvar/vaginal estrogen twice weekly.
Other natural products for vulvovaginal atrophy with a small amount of published research include hyaluronic acid, royal jelly, and two other studies on vitamin E suppositories
Reference: Emamverdikhan A, Golmakani N, SharifiSistani N, et al. Comparing two treatment methods of vitamin E suppository and conjugated estrogen vaginal cream on the quality of life in menopausal women with vaginal atrophy. JMRH 2014;2(4):253-261.
