It is estimated that anywhere between 50 and 60 percent of postmenopausal women have at least some symptoms of vaginal atrophy, including vaginal dryness. Some experts believe this number is low because women might feel embarrassed to discuss these symptoms with their doctors or just assume it is a “normal part of aging” and there is nothing they can do.
Vaginal atrophy is a thinning and drying of the vaginal walls often caused by the decrease in estrogen in the years leading up to and after menopause. The dryness can cause other problems:
Your doctor can diagnose vaginal atrophy and vaginal dryness based on your description of symptoms and a pelvic examination. Your doctor might suggest that you avoid using douches, taking bubble baths and using scented soaps or lotions near your vagina as these can all increase your dryness. There are also a number of different treatments available for vaginal dryness.
Over-the-counter vaginal moisturizers and lubricants
Vaginal moisturizers are available at most pharmacies. They can help to keep the vagina more lubricated and can be used on a daily basis. For painful sex, using a water-based lubricant, such as K-Y Lubricants or Astroglide, can help reduce the pain and irritation from friction.
Vaginal dryness caused by the decrease in estrogen can be helped by topical estrogen. These treatments replace some of the estrogen your body no longer produces but do not increase estrogen as much as oral estrogen replacement therapy. Topical estrogen treatments are available three ways:
Estrogen ring - a flexible ring inserted into your vagina by your doctor that releases a steady stream of estrogen. Your doctor must replace the ring every 90 days.
Estrogen tablet - You insert a tablet with an applicator into your vagina. The tablet is inserted once a day for two weeks, then twice a week for as long as needed
Estrogen cream - Cream is inserted into your vagina with an applicator. This is done once a day for one to two weeks and then one to three times per week.
Because these products contain estrogen, there is a risk of side effects such as vaginal bleeding and breast pain. They should not be used by women who shouldn’t have estrogen treatment, such as those pregnant or nursing, those who have vaginal bleeding (not from menstruation), or those with a history of breast or endometrial cancer.
Hormone replacement therapy
Hormone replacement therapy (HRT), helps to relieve the short-term symptoms of menopause, including hot flashes, night sweats and vaginal dryness. HRT contains oestrogen in higher doses than the vaginal estrogen treatments. It can be taken via a tablet, skin patch, gel or nasal spray. HRT can reduce symptoms of menopause and can improve your quality of life. It may also reduce your risk of later developing osteoporosis.
There are also risks and side effects of estrogen replacement therapy. Studies have shown a possible increase in the risk for breast cancer, uterine cancer, ovarian cancer and heart disease. You might also have a higher risk of developing a deep vein thrombosis, which is a blood clot. These are dangerous because there is a chance the blood clot can travel to your lungs and cause a pulmonary embolism.
Your risks for these conditions is based on family history and your lifestyle choices, for example, not smoking can reduce your risk of heart disease.
In addition to these traditional treatments, in 2014 the FDA approved a laser treatment for vaginal dryness. In this treatment, lasers help to remove dried skin which promotes the growth of collagen inside the vagina. The treatment is done in three sessions, six weeks apart. Because it is relatively new, you might need to check with your doctor to find out if this treatment is available in your area.
For more information on vaginal atrophy:
Half of Postmenopausal Women Face Challenge of Vaginal Atrophy
The Benefits of Vaginal Creams
Entering Menopause Means Making Vaginal Health a Priority
Tips for Talking to Your Partner about Vaginal Atrophy
When Sex is Painful: 5 Possible Causes