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Vaginal dryness is an often overlooked, but common condition that affects many women, especially during menopause. If you're experiencing vaginal dryness, explore the causes of vaginal dryness and discover a variety of natural vaginal dryness treatment solutions.
Hormonal Changes and Vaginal Dryness in Menopause
Menopause is a natural phase in a woman’s life, but the hormonal changes it brings about can lead to various health challenges. Although there are many menopausal symptoms that improve over time, one of the most common and enduring side effects is vaginal dryness.
During perimenopause the body's production of estrogen gradually decreases. Without replacement, this low level of estrogen persists after menopause.
During perimenopause estrogen levels vary across the menstrual cycle When estrogen drops low it can reduce vaginal discharge so that women can experience more vaginal dryness in certain parts of their cycle than they have otherwise previously experienced.
As the estrogen levels get persistently low, typically in later perimenopause and postmenopause, it can lead to thinning and drying of the vaginal walls and the vulva skin. It also leads to a reduction in vaginal discharge production, lower levels of natural vaginal lubrication, changes in the vaginal pH and the vaginal microbiome.
Symptoms of Vaginal Dryness
These changes to the vagina and vulva skin can cause:
discomfort,
burning,
a raw sensation
vaginal itching,
irritation,
pain during sexual intercourse, masturbation or self-pleasure.
Often this pain or discomfort can have other consequences as it can lead to avoidance of sex or lack of pleasure during sex, and can contribute to emotional distress, anxiety or depression and relationship issues. At it's most severe, there can be vaginal bleeding and tearing of the skin.
Genitourinary Syndrome of Menopause (GSM)
The accumulative changes to the vagina that occur due to loss of estrogen and testosterone used to be called vaginal atrophy, but now it is recognised to be a part of what is termed genitourinary syndrome of menopause or GSM.
GSM includes changes to the vulva, vaginal tissue, clitoris, labia, and urethra as each of these areas of the body contain hormone receptors both estrogen and testosterone and depend on these hormones to maintain healthy skin structure.
Associated symptoms that can occur alongside vaginal dryness due to changes in the skin and vaginal microbiome include urethral irritation and recurrent urinary tract infections.
Vaginal microbiome:Â The Forgotten Factor
The vaginal microbiome, the community of microorganisms that reside in the vagina, plays a crucial role in maintaining vaginal health.
At menopause the number of Lactobacillus -lactic acid producing bacteria declines, and there is an overgrowth of Gardnerella vaginalis, Ureaplasma urealyticum, Candida albicans, and Prevotella spp. These changes change the vaginal pH, and contributes to a decline in the vaginal skin integrity and increases vaginal dryness (Menopause and the Vaginal Microbiome 2016).
How common is vaginal dryness in menopause?
At least 50 percent of menopausal women experience vaginal dryness after menopause. It is typically progressive and does not get better without treatment (GSM Review 2021). Among postmenopausal women, up to 90 percent of women experience vaginal dryness and vaginal symptoms relating to low estrogen. Up to 90 percent of women don't seek treatment for their vaginal dryness.
What Causes Vaginal Dryness in Menopause?
1. Hormonal Changes
Estrogen plays a crucial role in maintaining the health and lubrication of the vaginal tissues. A decline in estrogen levels, as happens during menopause, is the primary cause of vaginal dryness.
You may have experienced similar vaginal dryness during breastfeeding when your estrogen levels were low.
Low of testosterone also contributes to vaginal dryness.
2. Medications
A number of medications can have a further drying effect on the body including contributing to vaginal dryness. These include:
decongestants
oxybutynin
anti-estrogenic medications such as tamoxifen and raloxifene used in cancer treatments and
some antidepressants.
Talk to your health provider if you think your medication may be exacerbating your vaginal dryness.
3. Other skin conditions
Menopausal vaginal dryness can be complicated by coexisting skin conditions or systemic conditions that cause vaginal dryness including:
eczema,
lichen sclerosus,
lichen planus,
psoriasis,
autoimmune disorders such as Sjogren's syndrome or lupus.
These conditions have additional treatment than what is needed for vaginal dryness. If you have skin changes or rashes, it is important to see your health provider to determine the cause and appropriate treatment.
4. Environmental Factors
Environmental factors can also contribute to vaginal dryness in menopause. This includes exposure to irritants, such as chemicals, perfumes or dyes found in:
fragrances,
laundry detergents,
bubble bath,
soap or
fabric softeners.
It is important to be mindful of these potential irritants and opt for fragrance-free and hypoallergenic products when possible.
Natural Treatments to Relieve Vaginal Dryness
When it comes to addressing vaginal dryness, a multi-faceted approach is often the most effective. Here are several natural treatment options that can help to alleviate the symptoms and improve vaginal health and include hormone replacement, moisturisers and lifestyle changes.
Hormone Treatment for Vaginal Dryness
The number one treatment for vaginal dryness due to menopause is to replace the hormones needed to maintain key aspects of vaginal skin health.
In most countries, hormonal treatments for vaginal dryness need to be prescribed by your health provider but in some countries there are some options available over the counter at your pharmacy such as Gina estrogen tablet which can be bought at pharmacies in the UK.
Vaginal Estrogen Cream
Topical estrogen cream is effective for relieving symptoms of vaginal dryness. Vaginal estrogen creams typically contain low dose body identical estrogens: estradiol or estriol (a less potent estrogen than estradiol). Estrogen creams typically come with an applicator, although some women prefer to insert the cream with their finger.
Topical estrogen therapy not only provides relief from symptoms, but also:
improves the overall vaginal health as well as improved health of the vulva and urethral tissues.
It also helps maintain the strength of the pelvic floor that support the wall of the vagina.
It improves vaginal blood flow (Estrogen Therapy During Menopause 1985).
It is usually used 2-3 times per week, but in severe cases it can be used daily until symptom control is achieved.
Vaginal Estrogen Pessary or Tablet
Vaginal pessaries also contain estradiol or estriol. They come in a soft carrier, dissolve in the vagina and are easy to insert into the vagina as they do not require an applicator.
DHEA Cream or Pessary
DHEA is a hormone that can be applied topically to the vagina. It comes in a pessary or cream. It is the precursor hormone to estrogen and testosterone. It improves vaginal dryness by increasing both estrogen and testosterone levels in the vaginal tissues.
DHEA can be helpful where estrogen alone has not been effective at reducing vaginal dryness. As with any hormone therapy, it's important to consult with a healthcare provider before use.
Testosterone Gel or Cream
Testosterone levels naturally decline in menopause, which can lead to decreased desire, arousal and pleasure during sexual activity and reduced vaginal lubrication.
Testosterone gel or cream applied vaginally alongside estrogen has been used to reduce vaginal dryness and increase the vaginal skin integrity and restore vaginal health (Vaginal Estrogen and Testosterone for Vaginal Atrophy 2016).
Testosterone cream or gel also has important benefits for increasing libido/sexual desire/pleasure for women in menopause (Testosterone For Women 2019) and anecdotally, women report if helps with mood and brain fog symptoms.
Supporting Moisture in the Vagina
Hyaluronic Acid Pessary or Cream
Hyaluronic acid is a substance found in the body that helps maintain vaginal moisture levels in tissues. It can be used as a pessary or gel to alleviate vaginal dryness. The use of hyaluronic acid has been shown to improve vaginal health and decrease symptoms of vaginal dryness as effectively as vaginal estrogen (Vaginal Hyaluronic Acid for Vaginal Dryness 2013).
An example includes:
PH-D Feminine Health: Vaginal Moisturizing gel is a pH-balanced, vaginal gel containing hyaluronic acid, boric acid, and vitamin E to support vaginal moisture and healthy pH levels.
Vaginal Moisturizer and Lubricant
Using high-quality vaginal lubricants and moisturizers can provide moisture to the vaginal wall to provide immediate relief from the discomfort of vaginal dryness. Look for products with natural ingredients and avoid those with harsh chemicals that can irritate sensitive tissues.
Vaginal moisturizers can be used daily to help maintain vaginal skin hydration and prevent vaginal dryness. They can also be used as a lubricant during intimacy to avoid skin damage or tearing.
Three of my favourite vaginal moisturizers/lubricants I recommend to clients include:
Nu Balm: which is made of olive oil, beeswax and kanuka oil.
Olive and Bee: is made of olive oil, beeswax.
Cocoa butter: it's soft, gentle and smells amazing.
These are all oil-based and so it is not recommended to use alongside condoms as they may break.
Holistic Treatments for Vaginal Dryness
Addressing vaginal dryness holistically means looking at the body as a whole. Here are some lifestyle changes to consider beyond topical hormones and moisturizers:
Hydration
Ensuring you're drinking enough water is the simplest step you can take. Proper hydration supports bodily functions, including the moisture levels in the vaginal tissues.
Dietary Changes
Incorporating foods rich in anti-oxidants and phytoestrogens, such as flaxseeds, soy, and chickpeas, can help support estrogen levels in the body and is generally a beneficial diet for menopause.
Omega-3 fatty acids, found in fish and flaxseeds, also have anti-inflammatory properties that can support vaginal health.
Phytoestrogens
Certain herbs or plants containing phytoestrogens appear from studies to help reduce vaginal dryness. The most effective phytoestrogens appear to be:
Pueraria mirifica,Â
isoflavone gel, and
topical fennel (Phytoestrogens for Vaginal Health in Perimenopause & Menopause 2019).
Prebiotics and Probiotics
Prebiotic and probiotic supplements and foods can help maintain healthy gut and vaginal flora, which is important for supporting overall moisture and health of the vagina.
Avoiding Irritants
Some bath and body products, as well as harsh detergents, can irritate the vaginal area and exacerbate dryness. Opt for gentle, unscented products to reduce potential irritants.
Frequently asked Questions
Is Vaginal Estrogen Safe To Use?
Vaginal estrogen used in low dose does not significantly raise levels in the blood stream.Â
Is Vaginal Estrogen Safe To Use After Breast Cancer?
It is important to consult with your healthcare provider before using any hormone therapy, and to get specific advice including vaginal estrogen, after a diagnosis of breast cancer.
Research suggests that the risk of developing breast cancer from topical estrogen therapy is no greater than your pre-existing risk without using it.
A large study published in JAMA Oncology with over 49,000 women with breast cancer followed up in Scotland and Wales for between 7 and 16 years found no increased risk of recurrence or death for women who used vaginal estrogen cream (Vaginal Estrogen Therapy and Breast Cancer Survival 2023).
Vaginal Dryness in Menopause: The Takeaways
Natural vaginal dryness treatments offer a safe and effective way to manage this common symptom of menopause. Vaginal hormone support, vaginal moisturizers and a lifestyle oriented to support vaginal health can make a significant difference to you vaginal health and quality of life.
While it's essential to consult healthcare professionals for personalized guidance, this holistic approach can provide a roadmap to improving vaginal health and overall well-being.
If you've found this guide valuable, share it with friends who may benefit from the information.
Nobody should have to suffer with vaginal dryness or pain when there are many effective treatments available.
Remember, the more we openly talk about vaginal health, the fewer women will suffer and the better we can support each other on our health journeys.
Join our Menothrive Program, to feel great and love your life during peri and menopause.
Book an appointment with Dr Deborah Brunt at Otepoti Integrative Health.
References
Phillips NA, Bachmann GA. The genitourinary syndrome of menopause. Menopause. 2021 Feb 1;28(5):579-588.Â
Muhleisen AL, Herbst-Kralovetz MM. Menopause and the vaginal microbiome. Maturitas. 2016 Sep;91:42-50. doi: 10.1016/j.maturitas.2016.05.015.
Fernandes T, Costa-Paiva LH, Pedro AO, et al. Efficacy of vaginally applied estrogen, testosterone, or polyacrylic acid on vaginal atrophy: a randomized controlled trial. Menopause. 2016 Jul;23(7):792-8.Â
Stute P. Is vaginal hyaluronic acid as effective as vaginal estriol for vaginal dryness relief? Arch Gynecol Obstet. 2013 Dec;288(6):1199-201.
Semmens JP, Tsai CC, Semmens EC, et al. Effects of estrogen therapy on vaginal physiology during menopause. Obstet Gynecol. 1985 Jul;66(1):15-8.Â
McVicker L, Labeit AM, Coupland CAC, et al. Vaginal Estrogen Therapy Use and Survival in Females With Breast Cancer. JAMA Oncol. 2024 Jan 1;10(1):103-108.
Islam RM, Bell RJ, Green S, et al. Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. Lancet Diabetes Endocrinol. 2019 Oct;7(10):754-766.