Vaginal Dryness During Menopause – How Can A Woman Deal With Vaginal Atrophy?
Menopause is an overwhelming phase for a woman who is about to complete her reproductive life cycle. The symptoms she experiences during menopausal phase can be devastating to her physical and emotional wellbeing. We will be discussing one such common symptom in this article.
• Vaginal atrophy or vaginal dryness is an inflammatory condition that may result in urinary tract infections
• Decrease in the estrogen level is the primary cause of vaginal dryness
• Lubricants, moisturizers and hormonal therapy are often used to deal with the condition
Vaginal atrophy also known as vaginal dryness or Postmenopausal Atrophic Vaginitis is a symptom of menopause that can affect the quality of life. In this condition, walls of the vagina become thin, dry and inflamed. Vaginal atrophy may lead to vaginal and urinary tract infections.
According to some experts, due to interrelated nature of vaginal and urinary symptoms, the more accurate term for vaginal atrophy and its accompanying symptoms should be ‘Genitourinary syndrome of menopause’ (GSM).
What causes Vaginal Atrophy?
The primary cause of vaginal atrophy is the decline in the level of estrogen hormone. Usually, the vaginal walls stay lubricated or moistened with a thin layer of clear fluid. The estrogen hormone helps maintain this fluid and keeps the lining of the vagina healthy. Without the presence of estrogen, vaginal tissue becomes less elastic, fragile and susceptible to injuries.
The decrease in estrogen may also happen:
• After the childbirth, during breastfeeding
• After surgical removal of the ovaries
• After chemotherapy cancer treatment
• As a side effect of hormonal therapy of breast cancer
• After pelvic radiation therapy
• During the years close to menopause (perimenopause)
• If you use anti-estrogen medication that treated uterine fibroids and endometriosis
How common is vaginal atrophy?
The condition most commonly occurs after menopause. As per American Association of Family Physicians, about 40 percent of women post-menopausal may have symptoms of vaginal atrophy.
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Signs that indicate vaginal atrophy
The decrease in estrogen level during the period of menopause results in less elasticity in the body tissues, especially the tissues related to urinary tract and genital areas. Gradually, due to lack of estrogen, the vagina and urinary tract become less elastic and less lubricated. Other symptoms include:
- Vaginal burning
- Discharge from vagina
- Itching in the genital area
- Light bleeding after sexual intercourse
- Pain or discomfort during intercourse
- Reduced vaginal lubrication during sexual intercourse
- Shortening and tightening of the vaginal canal
- Burning or pain during urination
- Frequent urinary tract infections
- Urinary incontinence (urgency of urinating)
Vaginal Atrophy Risk Factors
Some factors might contribute to vaginal atrophy such as:
- No Vaginal birth - Women who have never given vaginal birth are more vulnerable to this condition as against the women who have delivered their babies naturally.
- Smoking - Smoking has a negative effect on blood circulation. This results in less amount of oxygen transfer to the vagina and other tissues. Besides, smoking also reduces the effect of estrogen in women’s body. Moreover, women who are regular smokers will experience menopause earlier as compared to non-smokers.
- Irregular sexual activity - Sexual activity increases blood flow in the body, making the vaginal tissue more flexible. Lack of sexual activity will put you at the risk of getting vaginal atrophy.
Are there any complications?
Yes, there are potential complications associated with vaginal atrophy which include:
- Vaginal Infections - Vaginal dryness can result in acid imbalance that would give room to vaginal infections.
- Urinary problems - Symptoms that are related to urinary tract such as burning urination and urgency for urinating can give rise to infections of the urinary tract.
Diagnosis of Vaginal Atrophy
At the first meeting, your doctor would ask you about your medical history. The queries can include that for how long you haven’t experienced menstruation, whether you had cancer or not. She may also ask if you are using some perfumes, soaps or lubricants that could have increased the sensitivity in the genitals.
The gynecologist will then check for the presence of any physical signs in your external genitalia such as:
- Smooth, pale and shining vaginal lining
- Loss of flexibility
- Smoothness of external genitalia
- Thin pubic hair
- Bulges in the vaginal wall (pelvic organ prolapse)
- Enlargement of the uterine support tissue
The doctor could perform following tests:
- Pelvic examination - During the examination, the doctor will feel (palpates) the pelvic organs and also visually examine external genitalia, cervix, and vagina.
- Urine Test - A sample of your urine will be collected and analyzed for any urinary problems.
- Acid balance test - This involves testing a sample of vaginal fluids by inserting a paper indicator strip into the vagina.
- Smear test - This is a microscopic examination of the tissue scratched from the vaginal walls. It checks for bacteria and certain cells that are linked to vaginal atrophy.
- Blood samples - You might be asked for blood samples to examine the estrogen level in the body.
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How Vaginal Atrophy is treated?
There are numerous methods to treat vaginal dryness and other problematic symptoms of vaginal atrophy. The most effective of them is hormonal therapy.
- Systemic estrogen - For women in the menopausal phase experiencing symptoms such as mood changes, hot flashes etc. low dose of estrogen is considered an effective treatment. It can be given in the form of pill, patch or cream. It is inserted into the vagina via an applicator at bedtime. This therapy replaces natural estrogen, easing your symptoms.
- Topical or Local estrogen - For women feeling vaginal dryness and urinary symptoms, they might be advised to get estrogen via topical cream, ring, and tablet. The estrogen delivered through these means will be absorbed in the vagina.
These are water and silicon-based products that can deal with vaginal dryness effectively, especially during sex. Water-based products are considered good as they don’t contain glycerine, else you might feel irritation and burning.
Where lubricants are best for short term use, moisturizers can last for longer. You have to apply moisturizer every 2-3 days for better results.
Prevention Tips for Vaginal Atrophy
Apart from the mentioned above, engaging in regular sexual activity can help improve blood flow, hence restoring vaginal flexibility. Also, try to wear loose fitting clothes made up of cotton for improved air circulation. It would make the environment less ideal for bacteria. Some experts also believe that Vitamin E oil is a good lubricant while some other suggests Vitamin D helps absorb calcium and increase moisture in vagina.
Vaginal atrophy is one of the conditions that is not outspokenly discussed with the physician due to fear of embarrassment or due to reluctance. So if you are suffering from this condition, talk to your gynecologist and explore your best possible treatment options.
1. Gandhi J., et al.(2016, December).Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management. read more
2. Grant M.D.,et al.(2015).Menopausal Symptoms: Comparative Effectiveness of Therapies. read more
3. Vaginal Atrophy(2017, October) read more