We hear a lot about hot flushes in the menopause, but vaginal dryness and pain is every bit as difficult to cope with and rarely talked about.
Lack of oestrogen to the vagina causes vaginal atrophy, a thinning of the vaginal walls accompanied by loss of elasticity of the tissues around the vagina and reduced production of vaginal fluid. So many women are really afraid of this because they think that once they have vaginal atrophy its permanent – its not! In fact vaginal atrophy is easily treatable and reversible with oestrogen replacement therapy.
Lack of oestrogen to the vagina can cause all sorts of symptoms such as dryness, burning, itching, incontinence, painful sex and more urinary tract infections. Vaginal pain causes around 60% of women to experience lack of libido. Smear tests become agonizing. Half of women with urinary incontinence never report it to their doctor, and 70% of women say their doctor never raises the subject with them, according to the International Menopause Society.
This is a real problem because many women suffer in silence when there is absolutely no need for them to.
How to reverse vaginal atrophy:
Oestrogen therapy can be localised (in the form of pessaries that come in tablets that you insert into the vagina, or vaginal creams) or oestrogen therapy can be systemic (oral or transdermal hormones will also help relieve vaginal dryness in most women). Some women need a combination of localised and systemic oestrogen therapy to improve their symptoms of vaginal dryness. Think of vaginal oestrogen as preventative medicine – it helps strengthen the muscles and prevents against worsening atrophy and cystitis. It plays an important role in the prevention of recurrent urinary tract infections that are so often seen with lack of oestrogen. In the case of low libido, hormones such as oestrogen, progesterone, testosterone and DHEA may all play a role.
Other things that can help symptoms (but that won’t reverse vaginal atrophy by themselves) are:
Pelvic floor exercises: these strengthen pelvic floor muscles weakened by lack of hormones, childbirth and ageing and can help with stress incontinence.
Vaginal lubricants such as Replens and Sylk help relieve dryness and can be bought over they counter. They can provide temporary relief of symptoms but they do not contain oestrogen so do not address or reverse the underlying cause of vaginal atrophy.