An interview with Dr. Mickey Karram, M.D., conducted by Kate Anderton, B.Sc.
What changes do women experience following menopause?
The definition of menopause is when a woman stops menstruating for 12 consecutive months, and no other biologic or physiologic reason can be identified to explain why. What it means is that the ovaries have stopped releasing estrogen.
The symptoms that occur when a woman loses her naturally circulating estrogen are broadly classified into systemic symptoms (such as night sweats and skin dryness); as well pelvic floor changes (those which occur to the skin of the vaginal canal and the vulva).
These skin changes result in a condition called vulvovaginal atrophy, which is more recently called genitourinary syndrome of menopause.
Patients who develop this problem will start to have painful intercourse and potentially irritative symptoms of the bladder, such as urgency, frequency, and pain with urination. They can also experience extreme vaginal dryness and irritation.
What are the most common barriers preventing women from discussing post-menopausal symptoms with their clinician?
Many women feel that their symptoms are a natural part of aging and something they just have to live with. They have also been led to believe that replacing their estrogen is dangerous and can cause cancer.
Many women, therefore, feel that estrogen therapy would be very detrimental to them and believe that they would be better off living with their symptoms.
Why is it important that women talk to their clinicians about their sexual health after menopause?
Sexual health has been shown to be a very important aspect of overall health in general. Therefore, it is very important. In most cases, very simple therapies can cure the health problem they are facing.
What can clinicians do encourage women to speak about their sexual health after menopause?
I think initiating a dialogue on this topic when a patient comes in for her annual exam is very beneficial. I also recommend providing a patient with a questionnaire that she can fill out before her appointment. This way, she won’t feel embarrassed or uncomfortable bringing the topic up during the visit to her physician.
How are post-menopausal symptoms managed?
Historically, the management has been either systemic (throughout the body) or local (within the vaginal canal) estrogen therapy. The local therapy in the vaginal canal is either a cream, a tablet or a ring.
That being said, fractional CO2 laser therapy is a relatively newer option that can help with the intimate symptoms of menopause. It has been shown to be very effective in treating the symptoms of vaginal atrophy by applying it in the vaginal canal. Fractional CO2 laser therapy is especially beneficial for women who cannot take estrogen replacement, such as breast cancer patients, whose cancer is estrogen dependent.
Are laser treatments used routinely in healthcare?
Yes, fractional CO2 laser treatments have been utilized for long time in the skin of the face and neck, to increase collagen growth and revitalize these areas of skin.
Do you have any advice for women who may feel uncomfortable talking to their clinician about their sexual health post-menopause?
My advice to them would be to search out a healthcare provider that can help them with this problem. It is very treatable and when addressed in an appropriate manner, can have a very significant positive effect on the quality of life of a woman. No one should suffer in silence!
Where can readers find more information?
About Dr. Mickey Karram
Dr. Mickey Karram is an internationally renowned urogynecologist and pelvic surgeon. He is the Director of Urogynecology at The Christ Hospital and a Professor of Obstetrics & Gynecology at University of Cincinnati.
He was the first physician in the United States to perform the MonaLisa Touch therapy and is currently the lead investigator for the US research trials. He is the Director and Founder of the Laser Institute for Vaginal and Vulvar Health.