Overcoming Vaginal Dryness
Vulvovaginal atrophy (VVA) is a condition experienced by fifty to sixty percent of postmenopausal women. About half of women will have symptoms within five years of menopause, some immediately, and for others, it will increase over time. What’s more, symptoms can start during perimenopause and worsen during postmenopause.
Doctors are now using the term "genitourinary syndrome of menopause (GSM)" to describe vaginal atrophy and its accompanying symptoms. GSM is characterized by a variety of symptoms, such as vaginal dryness, burning, itching, vaginal discomfort, pain and burning when urinating, dyspareunia (pain when sexual intercourse or other sexual activity that involves penetration is attempted or pain during these activities), and spotting during intercourse. As you can imagine, GSM can be more than just a little irritation. Many women suffer in silence and don’t speak with their healthcare provider about the many treatment options available.
Not surprisingly, GSM can significantly affect your sex life and quality of life. So, what’s a girl to do? We’ll cover some options specifically around vaginal dryness, the most prevalent of the symptoms in this article.
What causes vaginal dryness in menopause?
As with many other physical changes experienced during menopause, hormones are heavily involved in the development of vaginal dryness. With the decline in estrogen levels during menopause, your vagina can take a hit.
Of course, there could be other factors involved too. Things like cold and allergy medications, antidepressants, douching (which can disrupt the bacterial balance in your vagina and lead to dryness), inadequate foreplay before intercourse, and an autoimmune disease called Sjögren's syndrome (which attacks moisture-producing cells in the body) are some examples.
To diagnose vaginal dryness, you will undergo a pelvic exam to look for the associated signs, such as thinning, paleness, loss of the folds of the vagina, dryness, and shrinkage of the labia.
Whatever causes vaginal dryness, we can all agree it’s not exactly fun for anyone. It can become extremely uncomfortable, both physically and emotionally. So what can you do about it? Below are some ideas.
6 ways to combat vaginal dryness during menopause
Topical estrogen therapy
This is a low-dose estrogen medication you apply to the vaginal area. It doesn't impact the hormones levels in your bloodstream as much or in the same way a systemic or system-wide hormone therapy. This is a much more targeted approach to hormone restoration.
There are a few types of vaginal estrogen many women use to increase estrogen levels. The first is a soft and flexible ring (Femring, Estring), which is inserted into the vagina and releases a consistent flow of estrogen to the vaginal tissues. This is replaced every 3 months. Next is a tablet (Vagifem), which is inserted into the vagina daily for two weeks, and then twice per week as needed. A gel capsule is also available (Imvexxy). Lastly, two types of estrogen creams (Estrace, Premarin) are often used, which are applied for a few weeks and then as needed.
Non-estrogen options include a vaginal suppository (Intrarosa) and an oral tablet called Osphena. Osphena is a selective estrogen receptor modulator (SERM) medication that is commonly prescribed for treating painful sex associated with vaginal dryness and atrophy.
The decision to pursue a particular estrogen treatment is best made in conjunction with a healthcare provider knowledgeable about the various options.
There are numerous products available that are worth checking out. Look for organic, natural products free of chemicals and toxins. In a recent study, researchers concluded that vaginal estradiol tablets appear not to add benefit for vulvovaginal symptoms beyond vaginal gel or moisturizer.
These products are also easy to find, and you’ve probably seen them before. Choose a water-based lubricant to avoid irritation. Many women also use natural lubricants with success, such as coconut oil, aloe vera, jojoba, and vitamin E suppositories, which can help lubricate and soothe the vagina.
Avoid things that make your vagina drier
This includes douching, and using fragrance-containing products near your vagina, like bubble baths, and scented soaps and lotions. If you smoke, quit, as this can also promote vaginal atrophy. Also, smokers often go through menopause at an earlier age. Staying hydrated, exercising regularly, and continuing to have sex as often as comfortable can also help prevent further dryness or atrophy.
Though limited, there is some research that adding probiotics can be beneficial for vaginal atrophy and dryness. This benefit may occur by creating a healthier vaginal pH, which, in turn, may improve vaginal health, including atrophy and dryness. There are many probiotic supplements on the market made specifically to target the female reproductive system. However, you can also add probiotics to your diet through whole fermented foods, such as tempeh, natto, miso, and sauerkraut.
Some people suggest that herbal supplements like black cohosh and wild yam may be able to relieve dryness caused by menopause, though there’s no strong scientific evidence to back this claim. If you are considering supplements, educate yourself on supplement safety and talk to your doctor, as there are potential side effects and interactions of certain herbs and minerals.
Be sure to speak with your healthcare provider to determine the best approach for you to overcome vaginal dryness. There are some considerations and potential side effects with every type of intervention. If you have a history of breast or endometrial cancer, you may not be a candidate for estrogen therapies. Stay persistent until you find something that works for you.
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Dr. DePree is the Director of Women’s Midlife Services at Holland Hospital in Holland, Michigan, and has practiced as a board-certified gynecologist and women’s health provider for 30 years. She is a certified menopause specialist and in 2013 was named Certified Menopause Practitioner of the Year by the North American Menopause Society for “exceptional contributions” to menopause care. Dr. DePree also founded the groundbreaking website Middlesexmd.com, a site focused on educating women about sexual well-being, particularly during the menopause transition, and offering curated products that support vaginal health and sexual wellness.