What Causes Vulvodynia After Menopause?

Posted on Thu, 17 Apr 2014

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Thu, 17 Apr 2014 Answered on

Tue, 6 May 2014 Last reviewed on

Question : I had my first case of vulvodynia when I was 28. I was on birth control for a year. I am not 55, post menopausal, and have it again for 2 years. Unrelenting pain 24/7. I feel it is hormone related, I started having hot flashes and urinary urgency about a year before the vulvodynia started again. Is there some kind of test for hormones? I am using progesterone pills and vaginal estrogen. Everytime I use hormones for any length of time I get a yeast infection. How can I get the levels correct? It seems my vaginal flora is a mess.

Answered by Dr. Dr. Rakhi Tayal (2 days later)

Brief Answer: Serum hormone levels can be checked. Detailed Answer: Hello, Thanks for trusting us with your health concern. Women have increased sexual and vaginal problems after menopause, including decline in libido, onset or increase in dyspareunia, vulvodynia and vulvitis, all of which have been traditionally attributed to urogenital atrophy. Vulvodynia is associated with a nerve related pain. Treatment includes topical anesthetics and medications that are used for neuropathic pain such as amitriptyline, gabapentin, valproic acid, or carbamazepine. In some cases, low-dose antidepressants, such as amitriptyline, starting at 10 mg/day and gradually increasing to 75 to 100 mg/day, imipramine, and desipramine, have been shown to be effective. Since you are already using the hormonal preparations a serum monitoring of these hormones and vaginal swab culture will help in treating any persistent infections responsible for inflammation. Please feel free to discuss further. I will be glad to answer the follow up queries that you have. Wishing you good health. Regards. Dr. Rakhi Tayal. For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Rakhi-Tayal

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Rakhi Tayal (31 minutes later)

Do I use a blood test to check hormone levels? What hormones can be checked? Is there any way to tell if my vulvodynia is hormone related or nerve related? I have been using estrogen suppository and oral progesterone for 7 weeks, with no improvement of pain. If the problem is hormonal, wouldn't the use of hormones for 7 weeks have helped by now? Do hormones increase the chance of yeast infections? Thanks

Answered by Dr. Dr. Rakhi Tayal (2 hours later)

Brief Answer: Due to neurological cause. Detailed Answer: Hello. Thanks for writing again. Yes the blood test can check for serum progesterone and estrogen levels. Checking FSH levels will give you an idea regarding the menopause. The symptoms should have improved by now since you are taking hormone therapy for 7 weeks. This is more likely to be a neurological cause. The hormones you are taking do not predispose you to yeast infections. However estrogen deficiency is associated with frequent vaginitis. Hope my answer is helpful. Do accept my answer in case there are no further queries. Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Rakhi Tayal (1 hour later)

Are you sure about estrogen and yeast infections? Usually women in menopause do not get yeast infections, but if they are on hrt that will increase the risk of yeast. Everytime over the last 2 years when I use estrogen vaginally for 3-4 weeks I end up with a yeast infection. Do you think using oral hrt would be a better option? Maybe not cause the yeast infections because it is not being delivered right to the vagina?

Answered by Dr. Dr. Rakhi Tayal (27 minutes later)

Brief Answer: Oral therapy will help. Detailed Answer: Hello. Sorry I meant vaginitis during the previous discussion. Yeast infections are common during the childbearing years. But, that does not mean that postmenopausal women can forget about yeast infections. The use of estrogen preparation vaginally predisposes you to yeast infection. Taking HRT orally will cause lesser yeast infections but occasional episodes may still be present. It is best to consult your gynecologist who will weigh the pros and cons of the oral therapy and will prescribe you in case you are a suitable candidate for this therapy. Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar