Menopause brings about many changes to the body. Some of those we can see and other changes may not be so visible.
One such subtle change? Vaginal atrophy. The condition affects about half of postmenopausal women, according to the Mayo Clinic.
One type of atrophy is vulvovaginal atrophy. “During perimenopause, less estrogen may cause the tissues of the vulva and the lining of the vagina to become thinner, drier, and less elastic or flexible—a condition known as vulvovaginal atrophy,” the North American Menopause Society (NAMS) noted. “Vaginal secretions are reduced, resulting in decreased lubrication. Reduced levels of estrogen also result in an increase in vaginal pH, which makes the vagina less acidic, just as it was before puberty.”
Another type is atrophic vaginitis. According to NAMS, “When ‘–itis’ is added to a word, it generally means inflammation. Inflammation of the vagina after menopause in a woman who is not using hormone therapy is called atrophic vaginitis. This condition can include redness of the vagina and vaginal discharge. It’s associated with the loss of estrogen after menopause and usually improves with the use of low doses of vaginal estrogen therapy.”
So how exactly does atrophic vaginitis affect a woman? In The Cleveland Clinic Guide to Menopause, Dr. Holly L. Thacker wrote, “Consider your reaction to a food that once made you sick, perhaps from an allergic reaction or food poisoning. If you even see the food again, you may begin to feel queasy. Your body is trying to protect you from further illness or injury. The same goes for sex. Your libido and sex drive drop because your brain associates sex with pain or injury. Not only are you physically unprepared for intercourse, you’re not interested.” The Mayo Clinic also noted that vaginal atrophy can affect urination through burning, urgency, and incontinence.
What can you do about these changes? The North American Menopause Society recommends the following:
- Regular sexual activity or stimulation (promotes vaginal health and blood flow)
- Vaginal lubricants (for temporary relief of dryness before and during sex)
- Vaginal moisturizers (for longer-term relief from dryness)
- Low-dose vaginal estrogen therapy in cream, ring, or vaginal tablet form (reverses underlying atrophy and dryness)
- Higher-dose hormone therapy throughout the body via pills, patches, and other preparations (reverses underlying atrophy and dryness, but generally reserved for women with bothersome hot flashes).
NAMS also recommends using water instead of soap on the inner part of the vulva, avoiding dyes and perfumes in toilet paper and laundry detergents, avoiding fabric softeners and anti-cling products, and not using perfumed products and lotions on the inner vulva.
Alternative therapies may help, although additional research is needed. The Mayo Clinic’s list includes:
- Black cohost. However a small study by the North American Menopause Society found that this herbal supplement was not effective in treating vaginal atrophy.
- Isoflavones. These plant-derived compounds are often extracted from soy and red clover. Evidence of their effect on vaginal atrophy is still slim. However, you should be careful taking these supplements if have an increased risk of a disease or condition that’s affected by hormones or if you’re already taking medications that increase your estrogen level.
- Vitamin D.
- Dehydroepiandrosterone (DHEA). This natural steroid is produced by the adrenal gland. Some studies have found that intravaginal DHEA tables may help to reverse vaginal atrophy without increasing circulating estrogen. However, additional studies are needed before DHEA can be considered for a standard therapy.