Author: Rita Galimberti (page 1 of 2)


Vaginal laser is a new treatment that has completely revolutionised the way we treat vaginal atrophy.

Chronic vaginal dryness and pain at intercourse is a very common problem in menopause. It is the result of the lack of oestrogens which causes changes in the vaginal mucosa. These changes are reversible using oestrogens (HRT) but not all patients want to use them and some patients might have reached the stage at which oestrogens are not just enough.

Using laser to treat this problem in the vagina is a safe way to turn the clock back and make patients comfortable very quickly.

There are two main types of laser: Co2 laser and Er:Yag laser.

Co2 laser cause some mucosa destruction in order to cause regeneration. There have been some concerns with this treatments in relation to scarring and pain.

The non ablative technology used with Er:Yag laser is very different as it uses a lighter thermal action and it has not been associated with any problems.

We have used this treatment with success and have been very impressed with the changes that this makes for patients.



Oestrogens are very important to maintain bone strength. We all have bone changes with age but these changes happen much quicker after menopause because of the lack of oestrogen.
This can result in osteoporosis or brittle bones, a condition in which any small injury can result in a fracture.
For many women this does not seem to be worrying and certainly does not appear to be as scary as cancer.
Unfortunately osteoporosis is a very debilitating disease. Reaching older age having good bones makes a huge difference in your quality of life.
It can make the difference between staying at home or requiring assisted accommodation.
It can limit your ability to travel and enjoy our life.
About 30 per cent of patients die after a major fracture.
There are many ways to improve your bones strength including HRT.
Make sure you include a bone discussion in your health plan.


At least one a week if not more often I encounter a patient who will tell me this story:
“I have not been feeling myself lately. I snap at the kids for no reason and then get really upset over it. I also get very anxious about things that did not bother me before and this is really affecting my work. I saw my doctor who checked my bloods test. It came back normal and therefore I was told it cannot be menopause and I should consider taking and antidepressant or antianxiety medication”
My dear patient if you are in the right age group you simply are perimenopausal.
I often tell my patients the story of similar things happening to me and recall of when I would not sleep at night over my first son starting secondary school and losing half of his uniform routinely at school. I laugh about it now.
Antidepressant can be a solution if you do not want to consider hormonal treatment. I would recommend you have an informed discussion with a menopause specialist as chances are that you will change your mind and that a low hormonal dose will make your life much easier.


When you start reading menopause website you will find an endless list of symptoms. From your joints to your hair every possible human symptom will be listed. This can be very confusing and in clinical practice I have shortened the list to four main symptoms.
These are the the symptoms that do affect your everyday quality of life and that is why I simplified the list.
If you score at least three of them and are in the
right age group (over 45) then your diagnosis is made. As I explained before don’t worry about your hormonal blood tests results as they will be often be normal.
The symptoms are:
-hot flashes and night sweats
-trouble in sleeping (very often caused by the night sweats but not only)
-mood changes including anxiety and irritability
-tiredness (again very often caused by not sleeping well)
You can decide to put up with all of this baring in mind it could continue for 10 years or to get some help. The choice is yours.


Not all medical professional have experience in looking after women who are experiencing menopause. Treatment can be quite difficult as it needs to be tailored to your needs. It is also important to address myths and anxiety about treatment so that you do not end up making the wrong choice.
Some general practitioners are very sympathetic and helpful in this situation. There a couple  of things that might help you decide if you need to see a menopause specialist.
1- Did your doctor listen to your symptoms or just suggested a blood test to make a diagnosis?
2-Did you get help in formulating a general plan to take care of your health that goes beyond just helping you with your symptoms. This is very important as menopause will affect the rest of your life and your ageing process.
Consider these two points and you will be very clear in knowing if you need further help!


One of the most common myths around menopause is that it will last a short period of time and then it will be over.
Most women talk about being through and done with it. Let’s clear this out:
-PERIMENOPAUSE  is the leading time to the end of your ovarian function. It can last from 2 to 15 years. This is the time when most women experience transition symptoms like hot flashes and mood changes.
-MENOPAUSE  is the period of your life from when your ovarian functions declines till the end of your life.
The rest of your life after menopause will hopefully be a long wonderful time but you are going to live it without the help of oestrogens. This is a major change that affects different part of your body.


I recently went home to visit my parents in Milan and found myself joining a Sunday morning exercise class with some old friends.
It was very enjoyable despite the heat and during a break a friend asked a few questions on vaginal dryness which was tormenting her. We started chatting about vaginal problems in menopause and I was giving her my best advice on what to do.
As we were chatting I realised that many of the other women (we were all of that age) were trying to listen and the chat become a lively group discussion. They were all keen on getting information and they all admitted to be plagued by the same problem.
I was quite surprised as I thought that Italian women would be normally be more open in relation to sexual issues. I turned out that when it comes to vaginal dryness and menopause even in Italy women are not happy to discuss it openly (apart from that protected environment) as it is embarrassing to admit that you have reached that stage.
So my message to all menopausal women is:
* You are not alone. We all have the same problem and we should not be afraid to discuss it and get advice
* Vaginal dryness is caused by the lack of oestrogen in menopause and it causes discomfort and painful sex
* This problem is treatable and there are new very effective remedies like vaginal laser that can greatly improve your quality of life
* Talk to your gynaecologist for advice and when you get better share your knowledge with your friends so we can eliminate this taboo



This is one of the commonest myths on menopause and its treatment. Every so often a patient will tell me: “I will have to go through symptoms anyway when I stop the treatment so I might as well do that now and be done with it”
This is really not true.
The duration of menopause symptoms is different and genetically predetermined for each woman.
It can vary from 1 to 10 years and sometimes more and there is no scientific way to know how long symptoms will last for you.
What happens is that if you stop treatment after 4 years and your symptoms were meant to last for three then you will not have them again.
If you stop treatment after 4 years and your symptom will meant to last for 8 then you will still have symptoms when you stop because it is too early for you to stop.
This is something that has created a lot of confusion and brought women to believe that symptoms will return when treatment is stopped.
It is a very personal decision if to start on not treatment but being fearful of having a delayed menopause should not be a factor.

HRT (Hormone replacement)

 There is very little question on the fact that hormone replacement therapy is the most effective treatment for menopausal symptoms. The concept is very simple. Your body does not produce oestrogen anymore (or it does at a very reduced rate) and this causes symptoms. To eliminate the symptoms you need to replace the hormones that you are lacking.
HRT is the only treatment that can tackle different parts of your body and help with:
-hot flashes
-night sweats
-vaginal dryness
-sex drive reduction
-bone thinning
-urinary incontinence
The problem is that there is a contrasting advice when it comes to taking HRT and may women are confused. 
For this reason you need to get proper information and make your own decision in relation to your menopausal treatment.
Again the facts are simple. Breast cancer is a common cancer and affects about 12 women over a 1000 in the over 50’s age group. In the same age group of women who take HRT the incidence is estimated to be 15 over a 1000, so that means 3 extra cases are possibly due to HRT. This mathematics applies to normal women with a normal baseline risk. 
Once you have this information you need to assess your current quality of life and decide what you want.
You either keep the symptoms or get treatment. It is important that when you are making the decision you look at all the consequences of estrogen depletion, in particular the vaginal problem which you are more likely to discover a few years later.
Take your time and make an informed decision. If you decide not to take HRT is absolutely fine but you need then to develop an alternative plan in relation to cardiovascular risk prevention and osteoporosis prevention.
You also need to know that you will not be able to change your mind and start HRT after a few years because taking it after not having had estrogens for a few years increases your risk of stroke and would not  normally be recommended.


This is one of the most common questions i get ask by patient. Diagnosing menopause can be tricky because it is a gradual process. Contrary to common belief it is not possible to do a blood test to tell you if you are starting menopause or not. Changes in blood levels will only be evident after menopause has happened and that is not very helpful because the vast majority of women feel unwell before than that and when their blood test is well within normal level. In medical terms we call this a retrospective diagnosis.

You really should not worry about pinpointing the exact time of going through the transition but you should worry instead about how the process is affecting your health and quality of life.

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