Vaginal Atrophy – How Does it Affect Our Menopause Journey?

We women talk about almost everything under the sun – career, family life, latest diet, movies and relationships, but never about vaginal atrophy. Most women are simply too shy to talk about it. No one has the courage to simply say, “Hey, are you having vaginal problems?”

What does vaginal atrophy mean? In medical terms, it is known as vulvovaginal atrophy (VVA), or atrophic vaginitis. The symptoms are light to moderate in perimenopause and during the menopause stages. However, the symptoms become worse in the postmenopausal stage.

What causes vaginal atrophy?

Vaginal atrophy happens in menopause because of decreased levels of estrogen. Before and after menopause, vaginal atrophy can present for several reasons.

• Effects of treatment for breast cancer, endometriosis, fibroids and infertility, which lower estrogen levels.
• Radiation treatment to the pelvic area and chemotherapy.
• Removal of the ovaries.
• Irritation from soap, detergents, douches, panty liners, condoms or lubricants.

Due to the decline in estrogen levels, our vagina loses its natural lubrication. As a result, the vagina also experiences a decrease in elasticity, moisture and strength. So, what does that leave?
A dry, fragile and very sensitive vaginal area! In return, this can cause a variety of symptoms.

Common symptoms related to vaginal atrophy

Many women in menopause have problems in the vaginal area that can affect our sex life. In fact, according to the CLOSER survey, 69% of women and 76% of their partners report that they avoid intimacy because of vaginal discomfort.
We may experience one or more of the following symptoms if we have VVA.

• Vaginal dryness, irritation and tenderness.
• Vaginal and vulvar itch, which means that the itch can be internal or external.
• Painful intercourse or dyspareunia.
• Bleeding after intercourse.
• Thinning of the vaginal skin, which allows the skin to be easily damaged.
• A tighter, shorter vaginal canal.
• Pain or burning sensation with urination.
• Pain during exercise.

If we cannot manage vaginal atrophy well, we are also prone to developing urinary incontinence and urinary tract infections. It may also put us at risk for bacterial or yeast infections in the vaginal region.

We do not mean to scare you off with this information. We want to let you know that many women have similar experiences  and that the symptoms of vaginal atrophy are manageable.

Ways to Manage Vaginal Dryness

As often as possible, we should first choose to manage our symptoms using natural methods. Here are some things you can do to help prevent and to decrease the effects of vulvovaginal atrophy.

Use it or lose it

What can you do prevent vaginal atrophy? Well, you know what they say: use it or lose it. Stay sexually active! It improves blood circulation in the vaginal area, and it stimulates you to maintain better and more natural lubrication. Another tip is to prolong foreplay to make intercourse more comfortable. By doing so, you stimulate better moisture.

 Maintain good hygiene practices

Good hygiene doesn’t mean that you have to wash your vaginal area frequently. It’s more about knowing what to use and what not to use. Here are some tips for you:

• Wear cotton underwear and clothing that is loose-fitting.
• Avoid regular use of douches and feminine products that are highly synthetic.
• Wipe from front to back to prevent infection.
• As much as possible, use only plain water to clean daily. Should you need soap, use unscented varieties.

Watch your plate

In light of the effects of atrophic vaginitis or vaginal atrophy, make sure that you hydrate the vaginal region well. To do this, eat foods that promote natural lubrication.

• Fill your diet with omega-3 fatty acids and protein.
• Include healthy seeds in your meals.
• Consume legumes, cherries, apples and celery.
• Introduce fermented foods in your diet for healthy probiotics!
• Making teas from phytoestrogenic and adaptogenic herbs can help balance estrogen and therefore help manage vaginal dryness and other menopause symptoms.

The bottom line is simple: always hydrate. Drink at least eight glasses of water each day to promote lubrication. It actually lessens your need for natural lubricants, because water can help you from the inside!

Move around

You know, exercise not only makes your muscles strong and your body healthy. It promotes better hormonal production too. It also provides proper support to your vagina! When you move around during a workout, you keep your blood flowing throughout your body, and that includes your vaginal area. As a result, it can enhance proper lubrication.

Your vagina will thank you even more if you include her in your workout routines. Yes! Have you heard of the kegel exercise? It’s an exercise for the pelvic floor that strengthens muscles, promotes lubrication, and improves sexual performance! It’s easy to do, and both you and your partner will love the effects of this exercise! Learn more about pelvic exercise.

Use non-hormonal treatments

If it takes a little while to heal from the inside, you can get an extra boost from non-hormonal treatments. Common available products include moisturizers and lubricants, which help hydrate the vulvovaginal area. Usually, these are topical treatments in the form of creams or suppositories.

Read our post on Vaginal Emollients, Soap, Moisturizers and Lubricants to learn about more products. Dr. Anna Cabeca shares how to make a DIY natural lubricant in this video using ingredients you have from your kitchen [8:23]:

Local Estrogen Treatments

Many menopausal women use hormonal replacement therapy, or HRT, to address their symptoms. The effect of this treatment are general or systemic. This means that if estrogen therapy is introduced, the vaginal region is not the only area that is affected by treatment. Other parts of the body, including the thyroid and breasts, will also be affected by estrogen or hormone treatment. However, most HRTs are known to have unfavorable side effects.

Because of the side effects of HRT, most women instead choose local estrogen treatments for vaginal conditions. These local treatments only work in an isolated region, so they do not affect other parts of the body. You can choose from the following forms of local estrogen therapy for treatment of vaginal atrophy:

• Vaginal ring – This is a flexible ring that provides a continuous low dose of estrogen for 90 days. This is recommended for women who have pelvic floor problems, because the ring can also serve as a support to the pelvic floor.
• Hormonal creams – These creams are applied inside the vagina. The cream is usually applied at bedtime for a week, or in accordance with a doctor’s prescription. As a maintenance treatment, the application can be reduced to two to three times each week. This type of treatment is beneficial for the extreme effects of vaginal dryness, especially during the postmenopause stage.
• Vaginal inserts – These suppositories are inserted into the vagina with the help of a hormone applicator. They can be applied every night for the first two weeks. After the second week, frequency can be reduced to three nights a week. Examples of these are Replens and Vagifem.

Deborah Murtagh and Gynecologist and Obstetrician, Dr. Jeanie McDonald talk about what happens in or intimate parts as we age and how we can gain back vitality and pleasure in this video [47:47]:

When to Talk to Your Doctor

The symptoms related to vaginal atrophy can often be relieved through simple measures. However, if the symptoms persist despite healthy management, it is best to visit your doctor for a consultation. Here are some situations that indicate you should talk to your doctor soon.

• When you experience painful sexual intercourse, even if you are using lubricants.
• If there is unexpected vaginal bleeding or discharge.
• If you experience a burning sensation or vaginal soreness.

More about Atrophic Vaginitis

Aside from hormone therapy, certain advanced treatment methods can help to improve your vaginal health. State-of-the-art technologies like the MonaLisa Touch and Femilift are available.

In conclusion, atrophic vaginitis, or vaginal atrophy, is a manageable problem. You may find it hard to talk about this, but we encourage you to address your symptoms, because there are ways to treat them.

How is vaginal atrophy affecting you during menopause? What can you do to feel better?

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References:

• Maire B. Mac Bride MBBCh, Deborah Rhodes MD & Lynne Shuster MD. “Vulvovaginal Atrophy“
• Gloria Bachmann MD and Nicole Nevadunsky “Diagnosis and Treatment of Atrophic Vaginitis“
• North American Menopause Society “Vaginal and Vulvar Comfort: Lubricants, Moisturizers, and Low-dose Vaginal Estrogen“
• US National Library of Medicine “Management of Vaginal Atrophy: Implications from the REVIVE Survey“