Menopause

Lichen Planus and Menopause:
Diagnostic and Treatment Differences

RESPONSE FROM DR. PEACOCKE

Dear Judy,

Menopause is very common and often causes vulvovaginal symptoms. Vaginal dryness and painful intercourse are the usual symptoms. However, itching, burning, vaginal discharge and blisters are not the symptoms or signs of the impact of low estrogen on genital tissue. Vulvovaginal dryness and sexual discomfort generally resolve easily with the use of local estrogen products.  If estrogen doesn’t help, or moreover, makes things worse, something else is going on.

Lichen planus is a rare disorder.  It occurs in mucous membranes, primarily in the oral cavity and in the vulvovaginal canal. The hallmark of lichen planus is blisters. These blisters can be small or large and occur in multiple areas of the mucous membranes.  By contrast, oral and genital herpes lead to blisters on only one side of the affected area at a time, not diffusely over the area.  Yeast infections are extremely common and are associated with symptoms of severe itching and discharge.  It is important if one considers a diagnosis of a yeast infection to confirm that diagnosis by microscopic analysis in the office and perform a culture when possible.  Certainly, when the “yeast infection” persists, diagnosis by culture is essential.  It is also important to diagnose genital herpes accurately by both inspection and confirmation by culture. In your case, there appears to have been no confirmation of a yeast infection other than by inspection.  Inspection may suggest vaginal yeast infection but must be confirmed. And, your herpes cultures were repeatedly negative. Treatment with vaginal estrogen did not improve the symptoms at any time.

The cause of lichen planus is not known. It is not caused by an infection, menopause, or sexual activity. Lichen planus is not contagious and cannot be passed on to a sexual partner. It can be associated with autoimmune disorders such as Hashimoto’s thyroiditis, primary hyperparathyroidism and Addison’s Disease. The mucous membrane variety affects women more than men and does so more often around the time of menopause. In general, the most common symptom of lichen planus is severe burning, which is worsened with sexual activity.  When the correct diagnosis is made, treatment is relatively straightforward using a short course of steroids in either topical or systemic fashion. When the symptoms of burning resolve and the blisters abate, treatment for the menopausal symptoms can proceed.

In your case, you had chronic vulvovaginal symptoms from two causes: lichen planus and menopause. Treatment of lichen planus, which is a complex disorder, allowed treatment of the menopause induced genital atrophy and dryness to be effective with local estrogen.  The good news is that lichen planus is generally easy to manage when recurrences do occur.

 

Join the conversation

This site uses Akismet to reduce spam. Learn how your comment data is processed.

  • lk September 10, 2018 at 7:12 am

    This is a very important article. Many, many women in menopause have this condition, but no one talks about it and very few doctors know about it. It took 3-4 years of painful, then no, sex with my partner before my condition was diagnosed finally by a doctor specializing in mid-life gynecology.

    Reply