The Menopause
Expert-approved ways to deal with vaginal dryness, with Dr Naomi Potter
Of all the menopause symptoms, vaginal dryness is one many of us may struggle to talk about. Yet, it’s incredibly common, with around 60% of menopausal and post-menopausal women experiencing this concern.
“It’s so easily treated, yet, because it’s embarrassing, fewer people seek help,” says Dr Naomi Potter, co-author of Menopausing.
Here, Naomi shares her advice for tackling vaginal dryness and the effective approaches we can take to ease symptoms.
Dr Naomi Potter’s advice for dealing with vaginal dryness
What causes vaginal dryness during menopause?
The vaginal mucus membranes are sensitive to hormones, particularly oestrogen. With declining hormones, they stop working like they should do, so you get a decrease in natural lubrication. You also get changes to the structure; the tissues are less bouncy and less plump. So, although it becomes very dry, there are bigger changes to the actual ‘architecture’ of the mucosa, which also contributes to symptoms.
From clinical experience, vaginal dryness is not something that everybody reports [during and after menopause], but it is very common.
What are the main symptoms and signs?
Dryness, pain, itching, pain with intercourse. You can get a paradoxical increase in discharge, because the vagina tries to self-lubricate. But it doesn’t do it properly, and it kind of goes into overdrive. You can get bleeding, because the tissues are much more friable and irritated, and cracking. If you’re still having natural cycles, then you could have a variation in symptoms throughout the month.
Urinary symptoms are also interrelated: urinary urgency, frequency, [needing to get] up in the night, incontinence, and infections.
It’s often misdiagnosed as thrush. We then find these women constantly taking very expensive over-the-counter thrush medication, but it doesn’t make any difference.
Can you have vaginal dryness without vaginal atrophy?
Yes, you can have dryness without vaginal atrophy. Atrophy is where tissues naturally thin and become kind of distorted; atrophy basically means ‘withers away’. The tissues thin, they lose their collagen structure, they lose their plumpness, they lose the natural folds that the vaginal wall normally has. The vaginal walls, rather than looking pink and plump, look pale and sometimes a bit mottled. Atrophy refers to the changes in its architecture.
Dryness is just literally whether something is dry or not; it’s a state of whether there is enough lubrication. However, they’re all kind of part and parcel of the same syndrome, which is genitourinary syndrome of the menopause.
What advice do you have for broaching the topic with a GP?
I think it’s having the understanding that GPs see vulva issues all the time. They are not remotely embarrassed by it.
[It’s important to] have an understanding of the anatomy and how to explain what it is that you are feeling. If you go along and say ‘my vagina is itchy’, the doctor will think that inside is itchy. Whereas if you say ‘my vulva is itchy’, then the doctor will know exactly what you mean. There’s a lot of misunderstanding about the basic terminology, which can confuse matters.
Then be very clear with how long you’ve had the symptoms for, when they occur, if anything makes them worse or better, and if you’ve tried anything. If you’ve got other perimenopausal symptoms, it’s worth bringing them up, so that it can flag with the doctor that the likelihood is this is perimenopause rather than thrush.
What are the options for treatment?
The first are things that you can do yourself at home. Avoid things that irritate, so bubble baths, bath bombs – even the type of soap that you use can cause irritation and itch. A lot of the time women find that what they used to do is now irritating, because everything’s just a bit less robust.
Then there are moisturisers and lubricants. If you find a good quality [vaginal moisturising] product, like the Yes! products, you can moisturise every day like you would do your face. Or just use plain water if you’re very sensitive, or you can use a very, very bland emollient that’s non-perfumed and non-coloured. If you’re going to use a soap product, definitely don’t use anything internally. Lubricants tend to be more important for intercourse. Definitely choose non-scented and non-glittered, and pH-balanced.
The other thing is choice of underwear and clothing – make things just a bit looser and less irritating. Some women find that some foods trigger dryness, but there’s none that are particularly known to be troublesome. Keeping a symptom diary and a trigger diary is the best way of identifying what’s causing dryness for yourself.
Then there’s hormonal options, which are not the same as using systemic HRT. You can use topical estrogens, which are extremely safe and extremely effective, and they come in a variety of products – gels, creams, pessaries, rings. They make a massive, massive difference very quickly, and are the kind of thing that you can stay on forever.
Aside from making things more comfortable ‘down there’, why is it important to treat vaginal dryness?
You’re much more likely to suffer from urinary tract infections (UTIs) if you have a genitourinary system that is atrophied and not in tip-top condition. Having recurrent UTIs is risky because you can end up with kidney damage. And, as women get older, by the time they’re in their 70s, 80s, and 90s, UTIs kill women.
Plus, you’re more likely to end up with vagina and vulva infections, as anything that breaks the integrity of those tissues can allow bacteria in.
Does it disappear once the menopause is over?
The cause is kind of characterised by hormonal turbulence, and all symptoms can seem really bad during that time [of menopause]. But vaginal dryness doesn’t really tend to get better.
I liken it to being a bit like your flower bed: you go on holiday in the summer and you leave the flower bed for two weeks, and it completely dries out. When you get back, you give it a massive drenching to get it back into condition. But you need to keep it topped up. Look after it forevermore, and it will thank you for it.
The updated edition of Menopausing, by Davina McCall and Dr Naomi Potter, is out now (HQ, £22).
Interview by Chantelle Pattemore
