Vaginal Dryness in Menopause, its causes, and the new ways we treat it
Vaginal dryness can be a problem for many postmenopausal women. About one-third of women experience it at menopausal onset and that number only grows as women age.
Vaginal dryness is a hallmark sign of the genitourinary syndrome of menopause, also known as atrophic vaginitis or vaginal atrophy. With this condition, vaginal tissues become thinner and more easily irritated — resulting from the natural decline in your body’s estrogen levels during menopause.
Vaginal dryness might not impact your day-to-day activities, but it can lead to itching or stinging. Many women also report that it has negatively affected their sex life leading to decreased sexual activity, causing frustrations for both partners.
Painful intercourse can then have a knock-on effect contributing to a loss of sexual desire causing sexual problems. The relief of symptoms often leads to increased sexual desire and arousal and better sexual health.
Pain during other times – in many cases vaginal dryness does not only cause pain during sex it can make it uncomfortable to sit, stand, exercise, urinate, or even work. Vaginal dryness can affect everyday life, whether women are sexually active or not. This can have a detrimental effect on the quality of life.
There are some minimally-invasive effective treatments for vaginal dryness that can help ease the symptoms and restore vaginal health.
Glands and their role in vaginal moisture
Natural lubrication produced by glands at the neck of the womb (the cervix) keeps the vagina supple and moist. The moisture moves slowly down through the vagina, keeping it clean and removing dead cells. The vaginal moisture is slightly acidic and this helps to keep the area healthy, preventing infections such as thrush. It is perfectly normal for the majority of women to notice a slight white vaginal discharge.
During sexual excitement, the Bartholin’s glands (two glands at the entrance of the vagina) produce extra moisture to aid sexual intercourse. However, a quarter of women aged 50-59 experience vaginal dryness problems during sex, and 16% experience painful sex.
What are the Causes of Vaginal Dryness?
During a woman’s childbearing years, the hormone estrogen is involved in lubricating the walls of the vagina. Estrogen also assists in keeping the vaginal walls healthy and supple. However, women going through menopause decrease their production of estrogen, leading to less moisture production and thinner, dryer vaginal walls. Doctors refer to this condition as atrophic vaginitis. The deterioration of vaginal health can lead to pain during intercourse and bladder issues such as urinary tract infections, frequent urination, and urinary stress incontinence.ARVE Error: src mismatch
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What are the Treatments for Vaginal Dryness During Menopause?
To remedy vaginal dryness and painful intercourse (dyspareunia) associated with the genitourinary syndrome of menopause, your women’s health doctor might recommend:
- Vaginal moisturizers (K-Y Liquibeads, Replens, others), applied every few days to moisturize and keep vaginal tissues healthy.
- Vaginal lubricants (Astroglide, K-Y jelly, Sliquid, others), applied at the time of sexual activity to alleviate pain during intercourse.
- A low-dose vaginal estrogen cream, tablet, or ring, to reinvigorate vaginal tissues. Even if you’re using systemic hormone therapy pills or patches, your doctor might recommend a low-dose vaginal estrogen treatment if vaginal dryness and related symptoms persist. If you’ve had breast cancer, talk with your doctor about the risks of vaginal estrogen therapy.
Regular sexual activity or vaginal stimulation — with or without a partner — also helps maintain healthy vaginal tissues in postmenopausal women.
For years the simplest way to treat vaginal dryness is to replace the estrogen lost during menopause with topical estrogen therapies. When applied directly to the affected area, estrogen hormone therapy can assist with lubrication without putting as much of the hormone into your bloodstream as regular hormone replacement therapy.
Women who need relief from other significant menopausal symptoms, such as hot flashes and night sweats, may want to consider higher-dose hormone therapy that raises estrogen levels throughout the body. However, for women without those other menopause symptoms, vaginal estrogen should be used since it is concentrated where it is needed and minimizes blood levels and possible side effects of estrogen on the rest of the body.
Additionally, severe vaginal atrophy may respond more quickly to vaginal estrogen therapy than to hormone pills or patches that deliver estrogen throughout the body.
There are three main types of topical estrogen:
Vaginal estrogen creams
These are creams that are inserted into your vagina with an applicator or applied externally in the genital region. Common estrogen creams include Premarin and Estrace.
Vaginal estrogen tablet
Much like a cream, vaginal tablets can be inserted into the vagina using an applicator. Vagifem is one common example.
These are small, elastic rings that can be inserted into the vagina, where it slowly releases estradiol into the surrounding tissues. The ring cannot be felt once inserted and can be left in place for 3 months until it needs to be replaced. The convenience of leaving the ring for 3 months is one of its benefits. Estring is one commonly prescribed vaginal ring.
What are the downsides of estrogen-based treatments?
Topical estrogen treatments reverse some of the effects of menopause by making up for lost estrogen production in the genital region. Unlike over-the-counter lubricants, which moisturize the area with artificial lubrication, topical estrogen therapies help the vagina to produce its own natural lubricants.
However, topical estrogen may not be a good fit for everyone. Additionally, women who have breast cancer or have a history of endometrial cancer may want to avoid estrogen therapy.
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A new treatment option that has recently come to the United States and is now available to our patients is called “Mona Lisa Touch.” This is quite revolutionary because it is almost 100% effective and requires no drugs at all.
The Mona Lisa Touch is a quick, painless laser treatment that delivers controlled energy to the vaginal tissue. It stimulates collagen production and is safe for those who are unable to use hormones. The full treatment requires 3 visits, 6 weeks apart, and takes less than 5 minutes per visit. No anesthesia or pain medication is needed.
Are There any Non-medical Options for Vaginal Dryness?
If estrogen therapy isn’t right for you and you are not able to afford alternative treatments, then over-the-counter lubricants, such as Astroglide, could be of benefit with no side effects. These water-based lubricants are inexpensive, safe to use with condoms, and are widely available at drugstores.
Discussing vaginal dryness with a healthcare professional can be daunting however it is often well worth it as they will be able to help.
Gynecologists do not recommend douching as a treatment for vaginal dryness. Avoid using douches, bubble baths, scented soaps, and lotions around the sensitive vaginal area. These products can worsen dryness. Douches, as well as heavily fragranced lotions and soaps, can dehydrate your vaginal walls and compromise vaginal health.
If you believe you are experiencing symptoms of, or suffering from Vaginal Dryness in Menopause, or have questions about it, please see your doctor.
We also invite you to establish care with Dr. Aliabadi. Please click here to make an appointment or call us at (844) 863- 6700.