Women going through the phases of menopause experience numerous symptoms, including hot flashes, weight gain, mood swings and so on. One of these symptoms is vaginal dryness. Vaginal dryness significantly decreases the quality of sex life as intercourse is often difficult and/or painful. As with every other symptom, the reason behind vaginal dryness is also hormone-related.
The cause of vaginal dryness
Menopause means the body stops producing some hormones, including estrogen. Vaginal dryness is usually one of many symptoms caused by so-called vaginal or vulvovaginal atrophy, which is caused by the absence of estrogen stimulation. If the hormone responsible for the healthy hydration of the skin tissue is missing, the skin tension subsides and the skin becomes dry and limp. Estrogen deficiency in the skin also affects the mucous membranes, which leads to urogenital complaints such as bladder infections and especially vaginal dryness in many women.
You are not alone
According to the Austarlian Menopause Society many women experience vaginal dryness during menopause, which often manifests as burning, itching, or lack of lubrication during sexual activity. And they have quite a big company. Data from the Study of Women Across the Nation (SWAN), which tracked more than 2,400 women over a 17-year-period, showed that, at baseline, 19.4% of women (aged 42-53 years) reported vaginal dryness. By the time the women in the study were aged 57 to 69 years, 34% of them complained of the symptom.
How can HRT help?
When the body stops producing hormones, it is possible to take them as medicine – this is called hormone replacement therapy, or HRT. Estrogen can be given either systemically, to increase the hormone’s levels throughout the whole body, or only vaginally, to increase levels just in that area. Unlike other typical symptoms of menopause such as hot flashes, atrophic symptoms affecting the vagina and lower urinary tract are often progressive throughout the menopausal transition and beyond, which means they frequently require treatment.
Hormonal products reverse the thinning and dryness of the vaginal tissues rather than just providing the temporary relief that lubricants and moisturizers do. They help through restoring the vaginal pH, improving the thickness and stretchiness of the vaginal tissue, and restoring vaginal blood flow, resulting in improved vaginal lubrication. They often also help to improve urinary symptoms.
"Studies have confirmed that although more than half of women develop vaginal dryness as they become more postmenopausal, most do not report symptoms. Some will try lubricants as they begin to develop pain with sex," says Dr. JoAnn Pinkerton, NAMS executive director. "However, if lubricants and vaginal moisturizers are not enough, there are highly effective vaginal therapies such as vaginal estrogen tablets, creams, the low-dose ring, and the new intravaginal dehydroandrosterone. It's shocking that less than 4% of women in the SWAN study were using these effective therapies by the end of the study period. For women, please report symptoms, and for healthcare providers, please offer safe, effective therapies."
Systemic estrogen
Systemic estrogen will also combat other menopausal symptoms such as hot flashes that may cause discomfort. If you have a uterus, this should be combined with another hormone called progesterone because estrogen by itself may increase the development of cancer in these areas. This also means that if you have had a hysterectomy, you can take systemic estrogen alone. It can be taken in pill form, inserted under the skin as an implant, or applied transdermally as a patch or skin gel.
Vaginal estrogen
If a lack of lubrication is the main issue for you, vaginal estrogens may be more suitable. In case of isolated vaginal symptoms, local estrogens are the safest hormonal therapy. This is also the case if you are unable to take systemic HRT for medical reasons. Local estrogens can also be used with systemic HRT. This kind of therapy comes in the form of a pessary or ring that needs to be inserted into the vagina, or as a cream. Vaginal HRT contains low doses of estrogen, and it does not need to be combined with progesterone.
If you would rather not use hormonal methods, moisturizers and lubricants are available and effective for local symptoms. However, make sure you choose a product that is balanced in terms of osmolality and pH, which is the most similar physiologically to natural vaginal secretions.