Brief Answer:
there are treatments to make you comfortable.

Detailed Answer:
Hello,

Thanks for the query to hcm,

Considering your menopausal status , it is natural for you to experience vaginal atrophy and dryness in view of low estrogen levels now in the body. However if you are sexually active and have been facing concerns regarding penetration and its been painful, the likely cause is yes vaginal mucous atrophy which can initiate frictional abrasions which can cause post coital spotting as in your case. The initial treatment offered is lubricant gels to help cope up but if there is still no relief then local oestrogen vaginal creams can be applied thrice a week for 3 weeks which help the vaginal mucousa to regrow and help avoid painful intercourse.

The most common vaginal oestrogen cream is ESTRIOL CREAM 1mg For local application intravaginally once a day at night, thrice a week for next 3 weeks.
You may discuss the option with your physician and take an informed decision.
I hope i have answered your query in detail,
Wishing you good health,
Regards

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Brief Answer:
vaginal atrophy....use oestrogenic foods in diet

Detailed Answer:
Hello,

Thanks for the follow up.

Unfortunately vaginal atrophy once set in is not reversible without oestrogen replenishment. So this can be done exogenously either through local oestrogen creams or incorporating oestrogen foods like flax seeds, soya bean, soya milk, tofu, chick peas, beans in your diet. This shall help you avoid exogenous hormone replacement.

Lubricants per se would cause only temporary assistance and would not help in any way in reversing vaginal atrophy. Vaginal dilatation in presence of vaginal atrophy will not give a lasting relief at all. The only way vaginal mucousa can be replenished is oestrogen replacement now.
In presence of dry vagina and atrophy sex would always be painful and difficult ( dyspareunia) and will not be as natural as you expect it to be.

I believe you should get your oestrogen levels tested; you may get a serum estradiol levels as well for knowing the baseline. If your levels increase over next 2-3 months after you make a change in your diet , then that would be the best way of adjusting your post menopausal lifestyle.

Regards

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Brief Answer:
I shall clarify.

Detailed Answer:
Hello,

I understand what you mean here. Let me clarify it this time.

Vaginal atrophy as I stated in my earlier reply unfortunately cannot be reversed. However I am being very clear in stating that if you don't take estrogen, vaginal atrophy will worsen for sure from what is now.

I do understand the risks involved in using estrogen replacements orally. Hence I gave you an alternative to include estrogen foods in diet. Luckily there are many good estrogen food available. You might try them. The risks you have with use of estrogen food is minimal unlike oral estrogen replacements.

Similarly as you are XXXXXXX and there is no natural oestrogen production anyways , hence I suggested instead of daily oestrogen replacement, thrice a week low dose estriol vaginal cream which shall act locally and promote mucous growth has been helpful to many women with problems similar to yours and with very few to no side effects. Hence this is still safer than daily hormone replacement therapy with 2mg estradiol tablets with progesterones.

Diet with specific food is just an addition to allow natural oestrogen's to you so that you don't have to be placed on higher dosages of oestrogen in form of medication.

If your doctors are against use of estrogen food or the estriol vaginal creams, then they may like to give you a break for sometime so that you can adapt to lubricants and can have normal sex life, but this may again be temporary and as you bleed after intercourse due to atrophy and dryness together even with use of lubricants, your chances of normal sex life would be jeopardised in absence of replacement.

In short and simple terms, though I cannot reverse the vaginal atrophy estrogen foods and topical vaginal creams should help you have smoother and enjoyable sexual experience without the pain and bleeding. It's much safer than oral replacement drugs.

Your specific question regarding danger in having sex:- i would just like to say that it is not dangerous as the bleeding in your case doesn't occur from uterus but from vagina due to friction induced injury for which we know the cause and hence can be treated with vaginal creams.

For immediate management of bleeding, if in excess you may opt for antifibrinolytics like Tranexamic acid TAB 500mg thrice a day for 2-3 days to stop excessive bleed ( if required). you can get it prescribed from your physician.

Hope its clear now. Yet, I will be glad to discuss and clarify further if needed.

Regards

PS: Diet changes shall not give you instant results for sure, it will take few months before difference may be seen.

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