Vaginal Dryness & Vaginal Atrophy
Vaginal atrophy is the medical term that refers to the
thinning of the wall of the vagina that occurs during menopause.
Vaginal dryness can affect any woman, however after the
menopause it is very common, affecting over half of post-menopausal women aged
between 51 and 60.
During menopause, estrogen production slows and then stops.
When that happens, a number of changes happen in a woman's body.
Periods become irregular and then stop. You may have hot
flashes, mood swings, a deeper voice, and an increase in facial hair.
What are the causes of vaginal dryness and vaginal atrophy?
The walls of the vagina stay lubricated with a thin layer of
clear fluid. The hormone estrogen helps maintain that fluid and keeps the
lining of the vagina healthy, thick, and elastic. During menopause, the drop in
estrogen levels reduces the amount of moisture available. It also makes the
vagina thinner and less elastic. This is called vaginal atrophy.
In addition to menopause, estrogen levels can drop from:
Childbirth and breastfeeding
Radiation or chemotherapy treatment for cancer
Surgical removal of the ovaries
Anti-estrogen medications used to treat uterine fibroids or
endometriosis
Autoimmune disorders
Allergy and cold medications and certain antidepressants
Douching
Lack of enough foreplay before sexual intercourse
What are the symptoms of vaginal dryness and vaginal
atrophy?
Vaginal symptoms that are commonly associated with vaginal
atrophy include vaginal dryness, itching, irritation, and/or pain with sexual
intercourse (known as dyspareunia). The vaginal changes also lead to an
increased risk of vaginal infections
Periods become irregular and then stop. You may have hot
flashes, mood swings, a deeper voice, and an increase in facial hair.
Emotional impact – vaginal dryness can make women feel
different. Changes to the body can be difficult to accept and pain and
discomfort caused by the condition can lead to a loss in self- confidence and
sexual confidence.
Other symptoms may include:
Reduced sex drive
Difficulty getting aroused and reaching orgasm
The surface of the vagina looks pale and thin
Narrowing or shortening of the vagina
Needing to pee more often than usual
Repeated urinary tract infections (UTIs)
How is vaginal dryness and vaginal atrophy diagnosed?
Medical history
Your doctor will likely ask you several questions about your
symptoms, some of which may seem unrelated. Make sure to inform your doctor of
all prescription and over-the-counter medications you’re taking.
Physical & pelvic exam
Your doctor will also conduct a physical exam, which
includes a pelvic exam. During a pelvic exam, your doctor will press down on
your abdomen while also inserting a gloved, lubricated finger into your vagina.
This will help them detect any changes or abnormalities of the reproductive
organs.
Pap smear test
If your doctor is unable to pinpoint a cause for your
dryness, or if you have other symptoms, you may need to undergo additional
tests. You may need to have a Pap smear, which is when your doctor collects
cells from your cervix to test for infection and cancer.
What is treatment for vaginal dryness and vaginal atrophy?
Once your doctor knows the underlying cause of your dryness,
you’ll be given treatment options.
Vaginal Lubricants
Hormone therapy
HRT is a treatment that involves taking medication to
replace the hormones that start to decline during the menopause.
Most women use one of three types of vaginal estrogen:
Vaginal estrogen ring (Estring). You or your doctor
inserts this soft, flexible ring into the vagina. There it releases a steady
stream of estrogen directly to the vaginal tissues. The ring is replaced every
three months.
Vaginal estrogen tablet (Vagifem). You use a disposable
applicator to insert a tablet into your vagina once a day for the first two
weeks of treatment. Then you insert it twice a week until you no longer need
it.
Vaginal estrogen cream (Estrace, Premarin). You use an applicator to
insert the cream into your vagina. You will typically apply the cream daily for
one to two weeks then reduce the frequency to one to three times a week as
directed by your doctor.
Hormone therapy may not be the right treatment for everyone.
Replacing natural estrogen can help with dryness, but can also trigger side
effects. These include:
Weight gain
Fluid retention
Nausea
Headaches
Breast tenderness
Spotting of the skin
Increased risk of stroke, blood clots, and breast and
ovarian cancers.
Alternatives to estrogen therapy
There are several alternatives to estrogen therapy, which
work very well and are often worth trying before using estrogen therapy. They
include:
Water-based lubricants, which can help add
moisture to the vaginal lining. Their effectiveness can last for hours at a
time, making them a good alternative when dryness causes discomfort during
sexual intercourse.
Vaginal moisturizers made specifically for
addressing dryness can be used to relieve symptoms for up to three days with
just one application.
Compounds in soybeans and soy products mimic the effects of
estrogen. If you add soy to your diet, you may experience some relief from
vaginal dryness.
Black cohosh is an herbal supplement that’s
considered by some to relieve menopausal symptoms. There are no significant
clinical studies that show its effectiveness.
Wild yam is another supplemental ingredient that promises to
relieve dryness, but evidence from research is lacking.
What is the outlook for vaginal dryness and vaginal atrophy?
Hormone treatments are available that are very effective in
reducing vaginal dryness, but whether or not to use hormone therapy is an
individual decision that must consider the inherent risks and benefits of the
treatment along with each woman's own medical history. Women with only mild
symptoms may experience relief by using vaginal moisturizing agents and/or
lubricants during sexual intercourse.
