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What Women Want to Know: Insights from a Gynecologist with an MPN

Women with Myeloproliferative Neoplasms (MPNs) face a unique set of challenges due to the symptoms that these diseases commonly cause. I can speak firsthand of these challenges because not only am I an OB/GYN but I also have an MPN.   I am 48 years old and was diagnosed with Polycythemia Vera in January 2011.  I am grateful to have well-managed, stable PV currently that allows me to still live life to the fullest, enjoy watching my children grow, and remain working full-time in a very busy private practice. However, I no longer take life for granted, knowing that my disease may progress at any time.

MPNs can complicate a variety of female functions– menstruation, sexuality, pregnancy, childbirth, and menopause.   Menopause can be a particularly troublesome time for women because of the disruption in quality of life that frequently accompanies it. Women with MPNs may have a more difficult time navigating menopause because one of the most successful treatment options for menopause, hormone replacement therapy (HRT), is usually contraindicated due to both HRT and MPNs posing a higher risk of blood clots and strokes.

Frequent symptoms of menopause include hot flashes, night sweats, insomnia, mood changes, irritability, brain fog, and decreased libido. For those of us with MPNs, we may identify some of these symptoms as being caused by our MPN in general, thereby magnifying the severity of the symptoms that we may encounter.  The gynecologic symptoms of menopause include vaginal burning, irritation, dryness, painful intercourse, urinary urgency, and burning with urination with or without urinary tract infection.  These sexual side effects of menopause can be quite disruptive, made worse by the fact that 64% of MPN patients experience some degree of sexual dysfunction, and 43% report severe symptoms.  (Cancer, 2016).

The good news for those of us MPN patients suffering with some of these menopause symptoms is that even though we may not be candidates for systemic HRT, we frequently can use vaginal hormone replacement to alleviate our vaginal and urologic symptoms.  In other words, we can safely use a vaginal estrogen formulation to help with vaginal dryness or pain with intercourse but be cognizant of the fact that it will not typically help with our hot flashes or night sweats due to it not raising our blood levels of estrogen.  By being localized vaginal therapy, it does not increase the risk of blood clots or strokes, thereby making it permissible for most of us with MPNs.

Topical forms of low dose vaginal estrogen include Estrace®vaginal cream or Vagifem®vaginal tablets, and neither elevate blood levels of estrogen, indicating they mainly impact the vulvo-vaginal tissues. Another prescription option is Intrarosa®, a vaginal DHEA tablet that our body converts into estrogen and testosterone in the vagina. Non-hormonal options for vaginal dryness and painful intercourse include vaginal lubricants/moisturizers such as organic coconut oil, olive oil or flaxseed oil, or over the counter lubricants such as Organic Glide™.  An exciting new treatment for painful intercourse and vaginal dryness is MonaLisa Touch™.  It is a non-hormonal, vaginal laser treatment that after a series of treatments, can increase vaginal moisture and elasticity and decrease pain, burning and dryness. Statistically significant improvement is noted after three laser treatments six weeks apart.  All these options are safe and effective and can be used by us with MPNs. However, each of us and our MPNs are different, so I recommend having a discussion with your women’s healthcare provider to find the perfect option for you.

Remember, even though as females, we may suffer with unique challenges from our MPNs, we are strong and resilient.  Let me leave you with one of my favorite quotes, “A strong woman knows she has strength enough for the journey, but a woman of strength knows it is in the journey where she will become strong.”  Unknown

To Your Health,

Dr. Couri

Written for and published by MPN Advocacy & Education International

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