How to treat vaginal dryness and atrophy during (and post) menopause

The last census accounted for approximately 64 million postmenopausal women in the United States. The average age of menopause is 51.3, and with this transition women are faced with plummeting estrogen levels. After menstrual cycles have ceased for about 5 years into the menopausal transition, approximately 40-50% of these women will experience dryness or atrophic changes in their genitopelvic region.

Of those women, only about 6-7%— or roughly 3 million— are actively treated with prescription medications. Many women are suffering in silence with this condition, unaware that there are safe, effective treatments.

Women may stop their monthly cycles for a variety of reasons:

• chemotherapy
• having had their ovaries removed (hysterectomy),
• or, most commonly, as the natural consequence of menopause.

The hallmark of menopause is a significant drop in estrogen. Estrogen, often known as the female dominant hormone, plays an important role in many bodily functions including bone integrity, cardiovascular fitness, and sexual and vaginal health. A lowered hormone level directly affects the vaginal lining, the vulvar tissue and the clitoris. The musoca may become pale and frail, and a thinning of the vulvar (vulvar lips) walls may occur.

Common indicators of vaginal dryness include:

• vaginal or vulvar irritation

• pain during intercourse, or pain while wearing undergarments

• vaginal discharge

• burning and itchiness in the vaginal area

• burning or pain during urination

• frequent or recurrent candida/ yeast infections or bacterial infections.

The loss of estrogen directly impacts the integrity of the vaginal pH balance, often leading to these worrisome symptoms.

If it’s painful, it’s not surprising that a woman avoids sex, which can take its toll on a relationship. Even sensual and emotional intimacy between a couple can become greatly compromised as a result.

The surprising truth is that simple solutions are available, including vaginal moisturizers and lubricants. In fact, most healthcare professionals recommend over-the-counter products as a first step in treatment.

Vaginal moisturizers support and hydrate the pelvic tissue. After consistent use (about 3 times per week), one can see changes and restoration of the ridges, folds and elasticity of the vagina. Moisturizers are used within the vagina and sometimes on the vulvar and are typically applied independently of sexual intercourse. There are many to choose from, and most are available at your neighborhood store.

Sexual lubricants are typically used during sexual activity, and they ease the discomfort that may be experienced during intercourse. Some women prefer organic or water-based lubricants for lovemaking, while others prefer the ones made primarily from silicone. You can also find options made without glycerin or paraben. Lubricants are most effective when they are applied to both partners prior to intercourse. Depending on its type, the lubricant may also need to be reapplied during the sexual experience.

Water-based lubricants do not stain sheets or clothing and may be used with a latex condom. Although they rarely cause irritation, they must be reapplied, as they can dry out with extended activity. Silicone-based lubricants are longer lasting. Slick and slippery, they usually do not need reapplication.

Silicone lubricants are often tasteless, odorless and have no stickiness or tackiness. Many couples also use them as sensual massage oils and lotions. Petroleum-based products should not be used with condoms, cervical caps or intravaginal diaphragms. They often destroy latex, stain fabrics and can irritate the vagina.

Some women prefer natural oil-based lubricants like those made from vegetable, avocado or coconut oil. Since they are gentle, they can be used with condoms, and are far less likely to irritate the vagina.

You and your partner may want to try out different options before settling on a favorite. Start out with samples and purchase the smallest quantities as you experiment. You may also want to discuss these choices with your healthcare professional.

Read labels carefully. It may be wise to avoid some bothersome additives that can be found in both moisturizers and lubricants. For example, flavors, bactericides, spermicides and parbens maybe problematic for the sensitive menopausal vagina and vulva.

When to see a healthcare professional

In some rare cases, non-hormonal over-the-counter products may not help alleviate severe pain and irritating dryness. In such cases, consult with your healthcare professional to discuss the prospect of using “minimally absorbed” estrogen hormone products (rings, creams, tablets).

Severe vulvar, vaginal and clitoral dryness due to lower estrogen levels can be a chronic and progressive medical disorder. “Dyspareunia” (painful intercourse) is a common problem that is not always discussed or adequately treated by the medical community. Many women shy away from talking about it with their healthcare professional, feeling it’s an embarrassing or private matter.

Here are some helpful hints to get the conversation started:

Prepare for your visit. A doctor’s appointment can pass with lightening speed and sometimes we lose track of the important issues we wanted to discuss. Prior to the visit, write down your questions or concerns and bring your notes with you. Think through the conversation in your head, choosing the words that feel comfortable to you. Your notes, questions and checklist may additionally be given to the nursing staff or your medical professional as a way to begin the discussion.

Build a relationship with your healthcare team. You may feel more relaxed discussing theses issues with the nurse or medical assistant before broaching the topic with your clinician. Foster those relationships— and don’t be shy to articulate your needs, concerns and desire for clear guidance. There is nothing embarrassing or “taboo” when it comes to your health. Give yourself permission to freely and openly discuss your vaginal concerns. By actively “owning” your vaginal health and sexual wellness, you will get the care and advice you need to make informed decisions.