Menopause or Lichen Sclerosus?
By Stephanie Hrehirchuk
Naturopathic Doctor & North American Menopause Society Certified Practitioner
“There’s no way every woman in menopause feels this pain.” I tried to get my point across to my doctor without becoming a difficult patient. “Having sex feels like broken glass!”
Looking back, I wish I had been a more difficult patient. I’d accepted the pat on the head and the menopause diagnosis and then continued to watch my vulva, along with my sex life and marriage, disappear. That was four years ago.
I turned 50 last November and decided that was my year to make my doctor listen. I booked my pap, informed my doctor of all the pain and discomfort I’d experienced over the years, and then awaited the results. My doctor called the following week with the all-clear. That can’t be. I pulled out a mirror and did my own inspection; something I should have done much sooner but was occupied with the perfect storm of divorce, single parenting, selling the family home, and Covid. I did not recognize my vulva. I also did not know the difference between vulva and vagina, part of the great education I’ve received while digging into the details of menopause health.
What happened next?
I do a disservice using “menopause” in the title of this article. While most women diagnosed with LS are menopausal, many are in their 20s, 30s, 40s, and even kids as young as three or four. Lichen sclerosus is a chronic inflammatory autoimmune condition occurring in genetically predisposed individuals. It is a life-long condition that is often masked by hormones. There is no recognized cure. LS also comes with a 3–6% increased vulvar cancer risk. While some sources state the number of individuals diagnosed with LS at 1 in 1000, according to The Royal Women’s Hospital in Australia, LS affects as many as 1 in 80 women (1). Keep in mind that this is an often misdiagnosed condition.
What you need to know
Cedars-Sinai identifies the common signs and symptoms that may be included with LS as:
- Vulvar itching (very common)
- Anal itching, bleeding, or pain
- Pain during sex
- Skin bruising and tearing
- Easy bleeding from minor rubbing of the skin
- Pain or bleeding when having a bowel movement
- Trouble urinating or pain with urination (2)
And while menopause alone can come with a host of challenging symptoms, there is a range of vulvovaginal conditions that cause physical and emotional pain everyday. Not all are LS. A gynaecologist or dermatologist can identify LS through clinical biopsy or visual diagnosis. The vulva may appear white or shiny. There may be areas of thickening or scarring. Each person’s experience varies. There are mild and severe cases.
Many have found relief through lifestyle changes, with or without the prescribed potent topical corticosteroids. Some with LS may also see a pelvic floor therapist, urologist, sex therapist or oncologist, along with their gynaecologist or dermatologist. The condition must be monitored and managed for life.
Personally, my pelvic floor physiotherapist was worth her weight in gold, helping me to improve the quality and elasticity of my vulvar tissues. Once I got over the initial shock of diagnosis, my background in nutrition and wellness, along with the countless hours I spent combing through research online, provided the information I needed to craft a personal protocol to manage LS and achieve remission. I include my year’s journey after diagnosis and the research I found of benefit in Lichen Sclerosus: Body, Mind & Spirit Practices to Heal the Stress of LS.
I’ve published children’s books on environmental stewardship and a multi-award-winning memoir. I even write romance novels under a pen name. As an author, I could have chosen to write about anything but LS. However, I didn’t want another woman to go undiagnosed for years and be told her suffering was just menopause.