New survey shows women still don't understand why sex hurts after menopause

Women's EMPOWER survey confirms reluctance to discuss sex problems and seek treatment despite major educational efforts

The Women's EMPOWER survey, an internet-based survey of 1,858 US postmenopausal women with symptoms of vulvovaginal atrophy (VVA). VVA, was specifically designed to assess women's awareness of VVA and their behaviors and attitudes associated with the treatment of symptoms. The findings came as little surprise to insiders in the medical industry, because they were consistent with six other past VVA surveys that also confirmed that postmenopausal women generally failed to recognize VVA and its chronic progressive course (including urinary problems) and were reluctant to discuss vaginal or sexual symptoms with their healthcare providers.

In the Women's EMPOWER survey, 81% of women were not aware that VVA is a medical condition. More than two-thirds of respondents were not familiar or only somewhat familiar with most of the prescription VVA products.

"The results of the Women's EMPOWER survey demonstrate and reinforce that, even with multimedia marketing and educational strategies in the years after other major VVA surveys, minimal progress has been made toward increasing women's awareness and understanding of VVA," says Michael Krychman, MD, of the Southern California Center for Sexual Health and Survivorship Medicine and a lead author of the Women's EMPOWER survey. "Women remain naive to the safe and effective treatment options that are currently available and are still, for the most part, underinformed and undertreated."

Contrary to popular belief, taking estrogen after menopause may not affect the memory and thinking abilities of healthy women no matter when the treatment is started. The study is among the first large, long-term clinical trial to examine the cognitive effects of estradiol, a type of estrogen, on women both close to and long after menopause.

Millions of women take estrogen to treat hot flushes, night sweats and other symptoms caused by menopause. Estradiol is the main type of estrogen produced by women in their reproductive years. Previously, researchers thought estradiol benefitted memory and thinking in women soon after menopause but not later, called the "timing hypothesis". Prior studies testing the theory have not found consistent results.

"This study fails to confirm the timing hypothesis," said study author Dr Victor W. Henderson of Stanford University School of Medicine in California and a Fellow of the American Academy of Neurology. "Our results suggest that healthy women at all stages after menopause should not take estrogen to improve memory. At the same time, women need not particularly be concerned about negative effects of postmenopausal estrogen supplements on memory when used for less than five years."

For the study, 567 healthy women between the ages of 41 and 84 were classified into early and late groups. The early group was within six years of menopause and the late group was at least 10 years postmenopausal. Participants took beta-estradiol every day or a placebo pill. The women also used a progesterone vaginal gel or placebo gel, unless they had a hysterectomy. The average treatment duration was nearly five years. Cognitive tests were performed at the beginning of the trial, 2.5 years and five years to measure thinking skills including verbal memory.