One of the most common menopause symptoms is vaginal dryness. It often occurs quickly and without warning in perimenopausal, menopausal, and postmenopausal women. It affects more than 80% of women just entering menopause and continues to affect up to 50% of those completing menopause. If you haven't experienced it, menopausal vaginal dryness may seem like a minor annoyance, but in reality it can be quite devastating. Vaginal dryness can ruin sexual intercourse for some menopausal women and leave behind feelings of inadequacy and guilt. Fortunately, effective treatments are now available for menopausal women who experience this symptom.
Vaginal Dryness in Menopausal Women
Also called vaginal atrophy, vaginal dryness is defined as a lack of adequate moisture in the vaginal area. It can affect women of all ages but it particularly affects women between the ages of 40 and 65.
The body naturally lubricates the vaginal walls with a thin layer of moisture. This moisture layer is made of a clear fluid excreted through the blood vessel walls around the vagina. When a woman is sexually aroused, these blood vessels receive more blood flow, stimulating the secretion of fluids, thus increasing vaginal lubrication.
However, hormonal changes that occur with menopause and other female life events can disrupt this process, both during sex and in daily life. Symptoms of vaginal dryness can range in severity from mild and slightly annoying to significantly life impeding.
The lubricant also has a slight acidity level, which helps to protect your vagina from foreign bacteria, keeping it free from infection.
Estrogen is the key to maintaining vaginal health and elasticity. As estrogen levels decrease during female menopause, the mucous membranes (vaginal epithelium) near your uterus produce less mucous. As a result, the vagina becomes very dry and thin. The walls of your vagina will become weaker and more sensitive. Acid levels also begin to decline, leaving you open to invading microorganisms, which can cause yeast infections and urinary tract infections. As your estrogen levels decline, less blood will circulate to the tissues in the pelvis, causing your vagina to thin and sag. Your vulva and vagina will probably begin to look different than it did before. Tissue and fat around the vagina will begin to disappear.
Symptoms of Vaginal Dryness
The most common symptoms of vaginal dryness are itching and painful sexual intercourse. Without its natural mucus, the vagina becomes very dry and fragile and cannot handle rough penetration. Forceful penetration may rip or tear the vaginal walls. You may have been wondering why you are experiencing vaginal bleeding after menopause. Spotting or bleeding can occur after sex if the vagina is too dry. A lot of women cannot stand to have sex at all, because the painful intercourse in menopause is simply not enjoyable.
Menopause itching due to dryness can also become painful and annoying. Incontinence also often occurs with vaginal dryness. As estrogen levels decrease, the walls of your vagina become increasingly weak, and are unable to prevent urine from escaping. Women with vaginal dryness are also at increased risk for developing vaginal infections like yeast infections, which are characterized by a thick, odorous discharge.
Treating Vaginal Dryness
Fortunately for menopausal women, vaginal dryness is not a condition that needs to be permanent. There are self management techniques to cope with this symptom, and varying degrees of treatment. It is recommended to begin with the least invasive method and progress up to more drastic treatments if symptoms are unaffected.
Your doctor will probably recommend that you try to have sex as much as possible. This may seem strange, but sexual intercourse will help stimulate the mucus glands at the base of the uterus, making your vagina moist. Women who refrain from sex often find that their dryness becomes even worse.
There are other lifestyle changes that can be implemented into a woman’s life as well, such as dietary adjustments or a different exercise program. Stress reduction techniques such as meditation or yoga can help women to relax if the vaginal dryness is stemming from emotional causes. Communication with one`s partner is recommended.
One of the recommended yoga exercises to treat vaginal dryness is as follows. It sounds simple, but requires concentration. Squeeze the anal/pelvic floor muscles firmly while inhaling; hold. Breathe out, holding the root lock and add a chin lock. Hold for two seconds. Visualize the nectar of the universe flowing down your spine and between your legs. Relax as you inhale.
However, as the primary cause of vaginal dryness in menopausal women is the natural decline in estrogen that is typical of this age group, the most logical method of restoring vaginal lubrication is to address the fundamental hormonal imbalance. Natural supplements can be an easy, safe and effective treatment option.
Some natural supplements to consider:
- Bryonia: root chakra overheated and dry, dry vagina, dry stools/constipation.
- Lycopodium: lack of root stability, vagina very dry, self-confidence withered, skin dry.
- Belladonna: vagina painfully dry and too sensitive to tolerate touch.
Recent studies have shown that a diet rich in soy flour and flaxseeds promotes vaginal health and prevents vaginal dryness. Drinking lots of water also can help your whole body, including your vagina, stay hydrated.
Sexual activity is a healthful prescription for postmenopausal women who have a substantially estrogenized vaginal epithelium. It has been shown to encourage vaginal elasticity and pliability, and the lubricative response to sexual stimulation. Women who participate in sexual activity report fewer symptoms of atrophic vaginitis and, on vaginal examination, have less evidence of stenosis and shrinkage in comparison with sexually inactive women. A negative relationship exists between coital activity, including masturbation, and symptoms of vaginal atrophy.
Because no positive relationship has been shown to exist between estrogen levels and sexual activity, coitus is not hypothesized to restore or maintain estrogen in postmenopausal women. The existence of a positive relationship between coital activities and both gonadotropins and androgens indicates the importance of these compounds to healthy vaginal epithelium when estrogen levels are decreased.
To ease physical symptoms, over-the-counter products such as vitamin E oil, vaginal moisturizers, or water-based vaginal lubricants may be a boon to sexual comfort. There are lubricants that you can use during sexual activity that will make you more slippery. These include K-Y Jelly and Astroglide.
There are also products you can use on a regular basis to eliminate vaginal dryness, such as Replens.
You can open vitamin E capsules and apply the oil inside your vagina daily for a week or two and then once or twice a week after that.
Drugs - Estrogen Replacement Therapy
Because the lack of circulating, natural estrogens is the primary cause of vaginal dryness, hormone replacement therapy is the most logical choice of treatment and has proved to be effective in the restoration of anatomy and the resolution of symptoms. Estrogen replacement restores normal pH levels and thickens and revascularizes the epithelium. Adequate estrogen replacement therapy increases the number of superficial cells. Estrogen therapy may alleviate existing symptoms or even prevent development of urogenital symptoms if initiated at the time of menopause. Contraindications to estrogen therapy include estrogen-sensitive tumors, end-stage liver failure and a past history of estrogen-related thromboembolization. Adverse effects of estrogen therapy include breast tenderness, vaginal bleeding and a slight increase in the risk of an estrogen-dependent neoplasm. An increased risk of developing endometrial carcinoma and hyperplasia is conclusively related to unopposed, exogenous estrogen intake. Factors that determine the degree of increased risk include duration, dosage and method of estrogen delivery. Routes of administration include oral, transdermal and intravaginal. Dose frequency may be continuous, cyclic or symptomatic. The amount of estrogen and the duration of time required to eliminate symptoms depend greatly on the degree of vaginal atrophy and vary among patients.
Systemic administration of estrogen has been shown to have a therapeutic effect on symptoms of atrophic vaginitis. Additional advantages of systemic administration include a decrease in postmenopausal bone loss and alleviation of vasomotor dysfunction (hot flushes). Standard dosages of systemic estrogen, however, may not eliminate the symptoms of atrophic vaginitis in 10 to 25 percent of patients. Systemic estrogen in higher dosages may be necessary to alleviate symptoms. Some women require coadministration of a vaginal estrogen product that is applied locally. Up to 24 months of therapy may be necessary to totally eradicate dryness; however, some patients do not fully respond even to this treatment regimen.
Other treatment options include transvaginal delivery of estrogen in the form of creams, pessaries or a hormone-releasing ring (Estring). Treatment with a low-dose transvaginal estrogen has proved effective in relieving symptoms without causing significant proliferation of the vaginal epithelium. The genitourinary pH level is also lowered, leading to a decreased incidence of urinary tract infections. Absorption rates increase with treatment duration because of the enhanced vascularity of the treated epithelium. The advantage of transvaginal treatment may be a decreased risk of endometrial carcinoma because a lower hormone amount is required to eliminate urogenital symptoms. Negative effects of transvaginal treatment include patient dislike of vaginal manipulation, less prevention of postmenopausal bone loss and vasomotor dysfunction, decreased control of absorption with vaginal creams compared to oral and transdermal delivery, and irregular treatment intervals that may cause patients to forget to administer the treatment.
Transvaginal rings offer convenience, constancy of hormonal concentration in the blood stream and a therapeutic value equivalent to creams without the need for frequent application. Control of hormone dosage is manipulated by changing the surface area of the ring. Atrophic vaginitis symptoms are relieved (with a dosage of 5 to 10 μg per 24 hours) without stimulation of endometrial proliferation, thereby eliminating the need to add opposing progestogen to the regimen. Rings may be removed and reinserted by most patients with little difficulty and can be worn during coitus.
In any case, consultation with a doctor is strongly advised with these options due to the possibility of complications.
Vaginal estrogen can be very effective in treating dryness. There are a number of methods currently available for taking estrogen vaginally. Two options are Premarin cream and Estrace. Both are very well absorbed. Some women think that because you apply the cream only inside your vagina, none of it will get into the rest of your body. This isn't the case. Some of the estrogen is absorbed into your blood. In fact, both Premarin and Estrace raise your blood levels of estrogen much the same as estrogen pills.
You only need a low dose of these products. One study found that a dose of 0.1mg provided effective relief from vaginal dryness. When you start using vaginal cream, you apply a small dab just inside your vagina daily for three or four weeks. Then you can reduce your use to once or twice a week. If you apply it daily for more than four to six weeks, it becomes less effective. It's important to remember that this is not a lubricant. You should use K-Y Jelly or Astroglide or another type of lubricant before having sex.
Easier and less messy are the new sustained release products, Estring and Vagifem. Estring is a low-dose estrogen ring that is placed in the vagina (much like a diaphragm) for three months at a time. It releases small amounts of estradiol over time. The estrogen dose is so low that it is not absorbed into the rest of the body. Newer products like Vagifem involve placing a tablet in the vagina rather than a ring.
Note to Women with Breast Cancer: Women who have had breast cancer can use Vagifem or Estring. Estrogen cream, such as Estrace is not recommended. Neither is Femring which is a form of hormone replacement therapy (HRT).
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