Hello,

Thanks for writing to us.

Most of the women develop vaginal discomfort especially during sexual intercourse following hysterectomy. It is much more common if they are in menopausal stage. At the age of 55, vaginal dryness secondary to menopause coupled with hysterectomy can cause this discomfort.

Other less likely causes include pelvic adhesion, infection or endometriosis.

Based on your symptoms and details provided, I would treat you as follows:

1. Use estradiol vaginal cream to improve vaginal secretions and to take care of dryness.
2. Use artificial lubrication (water based) during sexual intercourse.
3. Phytoestrogens (plant estrogen) have great role to overcome menopausal symptoms. They can be used.
4. Avoid mental stress and maintain genital hygiene properly before and after sex.
5. If you do not feel better, visit your gynecologist for detailed pelvic examination. Investigation like hormonal study as well as ultrasound scan is in order.

Hope, it helps for your information. If you need any clarification, you can freely ask me.

Wish your good health and take care yourself.

Regards,
Dr Soumen

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Hello,

Thanks for your follow up queries. Followings are my comments:

1) Ultrasound scan is able to detect pelvic adhesion and other abnormality (if any). Diagnostic laparoscopy can be performed alternatively. CAT scan is ideally not recommended in your case. Radiation exposure should be avoided.

2) As you have undergone total hysterectomy, certain risk of endometrial carcinoma is eliminated. Therefore, you can use it intermittently to cut down menopausal symptoms including vaginal dryness, itching and burning sensation.

3) Several studies shows that phytoestrogens (plant estrogen) like isoflavones has protective mechanism against breast/ endometrial carcinoma and reduce endogenous estrogen level. You can take soy, beans, peas, lentils, whole grains, rye, millet etc which contain plant estrogen.

It is quite effective among postmenopausal women as per trial study. You can take low dose progesterone supplement with it for more safety and to prevent hormone dependent carcinoma.

4) Bio-identical trochees are synthetic estrogen, having chemical compound, similar to hormone pill. It is misled by the term bio-identical. Several studies prove to have direct link in development of carcinoma. So, it is better to avoid in second time.

5) Yes, estradiol vaginal cream and isoflavone (plant estrogen) is available over the counter.

6) You can use water based lubricant like KY jelly, Astroglide, Vagisil etc. It is to be used 15 min before intimation.

7) No, bio-identical estrogen and phytoestrogens are not the same thing. However, it is misled by several companies. So, it is wise not to use any bio-medical product to avoid ill-health effect.

Hope, I have answered your all queries. If you do not have other queries, you can close the discussion.

Be well and stay healthy. Good luck.

Regards,
Dr Soumen

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Hello,

Thanks for your additional queries. Followings are my response:

1) You can take low dose progesterone if you want to use estradiol cream occasionally. Progesterone pill is not required for taking isoflavone. These are quite effective to cut down menopausal symptoms.

2) I prefer effective progesterone dose 15-30 mg daily for my patients with postmenopausal symptoms.

3) Brand name varies according to country origin. Therefore, you need to take a prescription from your doctor for the same.

4) The leaves of the walnut tree contain plant-based progesterone, according to a 2010 study published in the "Journal of Natural Products". But, there is no FDA approved supplement available.

5) Progesterone is natural hormone in the women body system. In menopause, it is markedly reduced and it is substituted with its supplement. It has protective mechanism against various disease and carcinoma in comparison to estrogen.

6) Yes, you need a prescription for progesterone supplement from your doctor and it helps to chose correct brand from local store.

7) Phytoestrogens are plant based. Therefore, it can be taken daily basis with earlier mentioned food stuffs. However, estradiol cream is made from synthetic estrogen hormone (steroid based). Therefore, you can use it intermittently.

Hope, your all queries are clarified. If you are satisfied with my answers, please write a review after closing the discussion.

Regards,
Dr Soumen

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