Conquering Vaginal dryness

Many women notice changes in their vagina and
genital area after the menopause. These changes
may include dryness and discomfort during sex.
There may also be bladder symptoms. These can
all usually be improved with treatment.
Treatment options include hormone replacement
therapy (HRT), oestrogen cream or pessaries and
lubricating gels.
What is atrophic vaginitis and what causes
it?
Before the menopause (often called the change
of life) the skin and tissues around your vagina
are kept supple and moist by fluids and mucus.
These are made by glands at the neck of your
womb. Oestrogen (the female hormone) affects
these glands. Oestrogen also affects your tissues
in and around your vagina, causing the lining of
your vagina to be thicker and more elastic.
Oestrogen also stimulates the cells that line your
vagina to produce glycogen, a compound which
encourages the presence of helpful germs
(bacteria) which protect your vagina from
infections.
After the menopause your ovaries make less
oestrogen. The lack of oestrogen leads to
thinning of the tissues around your vagina and a
reduction in the number of glands that make
mucus. You may also lose some fat tissue from
around the genital area. This may make the area
also look slightly different to how it was before
the menopause.
In summary, the hormonal changes that occur
during the menopause make your vagina shorter,
less elastic and drier. These changes usually take
months or years to develop after the menopause
and vary from woman to woman. Atrophic
vaginitis is the medical term for the condition
when these changes produce troublesome
symptoms.
How common is atrophic vaginitis?
After the menopause about half of women have
some symptoms related to atrophic vaginitis. You
are also more likely to experience symptoms as
more years pass after your menopause. It is
probably even more common than that, as many
women are embarrassed and feel they do not
want to trouble their doctor with these
symptoms.
What symptoms can occur?
The changes described above can occur without
causing any symptoms or discomfort. However,
some of the following symptoms may develop in
some women. Atrophic vaginitis is a common
(and usually treatable) cause of the following
problems. However, these problems can also be
caused by other medical conditions.
Pain when you have sex. This may occur
because your vagina is smaller, drier and less
likely to become lubricated during sex
compared with how it was before the
menopause. Also, the skin around your vagina
is more fragile, and this can make the problem
worse.
Discomfort - if your vulva or vagina is sore
and red.
Vaginal discharge. There may be a white or
yellow discharge. Sometimes this is due to an
infection. Infection is more likely if the
discharge is smelly and unpleasant.
Itch. The skin around your vagina is more
sensitive and more likely to itch. This can
make you prone to scratching, which then
makes your skin more likely to itch, and so on.
This is called an itch/scratch cycle which can
become difficult to break, and can be
distressing.
Urinary problems. Atrophic vaginitis may
contribute to various urinary problems. This is
because of thinning and weakening of the
tissues around the neck of the bladder, or
around the opening for urine to pass (the
urethra). For example, urinary symptoms that
may occur include an urgency to get to the
toilet, and recurring urinary infections.
What are the treatments for atrophic
vaginitis?
Not all women have all of the above symptoms.
Treatment may depend on which symptoms are
the most troublesome. Because the problem is
mainly due to a lack of oestrogen, it can often
be helped by replacing the oestrogen in your
tissues.
Hormone replacement therapy (HRT)
This means taking oestrogen in the form of a
tablet, gel or patches. This is often the best
treatment for relieving your symptoms, but some
women don't like the idea of taking HRT. There
are advantages and disadvantages of using HRT.
See separate leaflet called Menopause and
HRT for more detail.
Oestrogen creams and other topical
preparations
Sometimes a cream, pessary or vaginal tablet or
ring containing oestrogen is prescribed. A
pessary is a small soluble block that is inserted
into your vagina. The tablet is a very small
tablet that you insert into your vagina with a
small applicator. The ring is a soft, flexible ring
with a centre that contains the oestrogen
hormone. This ring releases a steady, low dose of
estrogen each day and it lasts for three months.
These preparations work to restore oestrogen to
your vagina and surrounding tissues without
giving oestrogen to the whole body. Usually the
treatment is used every day for about two weeks,
and then twice a week for a further three
months. After this the effect of the treatment is
usually assessed by your doctor. This treatment
usually works well but the symptoms may recur
some time after stopping the treatment.
Repeated courses of treatment are often
necessary. These preparations should not be used
as additional lubrication during sex; lubricating
gels should be used instead.
Note: the oestrogen creams and pessaries may
damage latex condoms and diapragms; if you
are using these types of contraception then it
would be preferable either to use vaginal tablets
or the vaginal ring.
Lubricating gels
If vaginal dryness is the only problem, or
hormone creams are not recommended because
of other medical problems, lubricating gels may
help. There are two gels which are available in
the UK that are specifically designed to help the
problem of vaginal dryness. They replace
moisture. They are Replens® and Sylk®. You
can buy these from the pharmacy and your
pharmacist should be able to advise you.
Note: Vaseline® can break down the latex in
condoms, so is not recommended for women
whose partners are using condoms.
Your symptoms should improve after about three
weeks of treatment. You should see your doctor
if your symptoms do not improve, as sometimes
these symptoms can be due to other conditions.
It is also very important to see your doctor if
you have any bleeding from your vagina if you
are receiving hormone treatment.