If you’re dealing with vaginal dryness, you’re definitely not alone. Many women notice that as they get older, their vagina feels drier, sore and less flexible, and they are more prone to bladder infections, especially after menopause. The culprit? Your hormones. As estrogen levels drop during perimenopause and menopause, the vaginal tissues lose the natural moisture and elasticity they had in your younger years.
This collection of symptoms is known as Genitourinary syndrome of menopause (GSM), and it affects up to 50% of postmenopausal women.
GSM is caused by the decline in estrogen levels during menopause, which can lead to vaginal atrophy, such as thinning, drying, and inflammation of the vaginal and urinary tissues. Some common symptoms of GSM include vaginal dryness, itching, burning, and pain during intercourse. Other symptoms may include urinary urgency, frequency, and incontinence.
The vaginal microbiome also changes with decreased levels of estrogen, leading to lower levels of Lactobacilli which leads to an increase in intravaginal pH, resulting in increased vaginal colonisation by harmful microorganisms (e.g., Enterobacter, Escherichia coli, and Gardnerella). This increases the risk of infection, and the prevalence of bacterial vaginosis becomes higher. UTIs can also increase.
As a naturopath, I believe in a holistic approach to managing women’s health concerns, and vaginal dryness is no exception.
But here’s the good news: while vaginal dryness is common, it doesn’t mean you have to put up with it. There are real solutions, and in this post, we’ll dive into why addressing them can make a huge difference in your comfort, health, and overall well-being
Here are some key interventions to manage and alleviate symptoms:
Prebiotics for GSM
- In mild cases, Lactulose can be applied vaginally or inserted in a capsule.
- Oral Lactulose may also provide support for gastrointestinal issues.
- In mild cases, applying strain-specific Lactobacilli-rich probiotics five days a month can improve lubrication and decrease sensations of atrophy.
Lubricants & Moisturisers
One of the most effective natural remedies for vaginal dryness is the use of vaginal moisturisers and lubricants. These can help to hydrate and protect the vaginal tissues, reducing dryness and discomfort.
- Daily vaginal moisturisers and lubricants for intercourse are essential. It may take trial and error to find the best fit.
- Look for products that are pH-balanced and osmolar-correct.
- Oil-based and water-based options can vary depending on preferences and compatibility with barrier methods.
- I recommend using products free from harsh chemicals and synthetic fragrances. Instead, opt for natural options such as VeeForMe Soothe & Plump, Olive and Bee, and Yes, which are made with soothing ingredients like aloe vera and calendula extract.
- Backed by research, there are also effective and safe vaginal moisturiser alternatives for women who cannot use vaginal oestrogen preparations. Find out more here.
Clinical Treatment: Allopathic/Medical
- Vaginal oestrogen preparations are highly effective for reducing GSM symptoms and reversing atrophic changes in the pelvic tissues. They improve blood flow and epithelium thickness in the vagina, bladder, and urethra.
- Estriol, the weakest form of oestrogen, is often preferred due to minimal systemic absorption. It cannot metabolise into estradiol or estrone, reducing risks.
- Low-dose vaginal estradiol tablets (10 µg) are also effective with minimal annual systemic absorption.
- Please note that these are not suitable for everyone.
Hormonal Therapy and the Microbiome
- Before starting low-dose oestrogen therapy, studies show a significant difference in vaginal microbiota between women with atrophy and healthy women, specifically in the balance of Lactobacillus and Gardnerella.
- Hormonal therapy can quickly increase the Lactobacillus population, improving vaginal health, though care is needed to avoid the risk of vulvovaginal candidiasis (VVC).
Microbiome and Hormone Replacement Therapy (HRT)
- HRT directly affects the dominance of Lactobacillus in the vaginal microbiota, helping to resolve acute and long-term symptoms of GSM.
- However, HRT may also increase the risk of Candida infections, particularly in women who were susceptible to it pre-menopause.
Co-management of GSM
- A combined approach of both holistic and pharmaceutical therapies can offer the best results, especially as GSM is progressive.
- Early pH testing could help identify GSM early, even if symptoms are mild.
- You need to check in frequently (symptoms change frequently).
- Working with health professionals ensures a tailored approach to managing symptoms and provides relief more effectively.
Another important aspect of managing GSM is maintaining a healthy diet and lifestyle. This can include staying hydrated, getting regular exercise, and eating a balanced diet rich in vitamins and minerals. Certain foods such as soy, flaxseed seeds, and oily fish may also help to boost estrogen levels naturally.
In addition, certain herbal supplements, such as sea buckthorn, black cohosh and red clover, may help alleviate symptoms of GSM by mimicking the effects of estrogen in the body. Oral Zinc and vaginal Vitamin E can also be important in helping to alleviate dryness due to low menopausal uterus levels. However, it’s always important to consult with a healthcare professional for specific brand recommendations, possible contraindications, and prescription protocol dosages before starting any new supplement regimen.
Important Takeaways:
- GSM or vaginal dryness is often underreported, and many women may accept it as part of aging, so it’s crucial to ask questions and check in regularly as symptoms evolve.
- Patience is key; treatments may not work immediately, but co-management with medical professionals can provide relief.
- Stay proactive in identifying issues early to find the right treatment plan, as symptoms can change rapidly.
Overall, vaginal dryness can be a frustrating and uncomfortable condition for many women, but the right interventions and addressing it early can greatly improve its ability to manage symptoms and greatly improve the quality of life during menopause. By focusing on natural remedies and lifestyle changes, women can take control of their health and well-being during this important stage of life.
Ready to take control of your vaginal health?
Book your naturopath consultation today, or schedule a discovery call to learn more!
References:
Angelou, K., Grigoriadis, T., Diakosavvas, M., Zacharakis, D., & Athanasiou, S. (2020). The Genitourinary Syndrome of Menopause: An Overview of the Recent
Data. Cureus, 12(4), e7586. https://doi.org/10.7759/cureus.7586
Burger H.G. Hale G.E. Robertson D.M. Dennerstein L. (2007). A review of hormonal changes during the menopausal transition: focus on findings from the Melbourne
Wang, Z., Wang, Z., Wang, L., Yao, W., Zheng, Y., & Huang, Y. (2022). Factors associated with anxiety and depression during the COVID-19 pandemic: A cross-sectional study in China. PLOS ONE, 17(3), e0266633. https://doi.org/10.1371/journal.pone.0266633
Women’s Midlife Health Project, Human Reproduction Update, Vol.13, No.6 pp. 559–565
Brotman, R. M., Shardell, M. D., Gajer, P., Fadrosh, D., Chang, K., Silver, M., … Gravitt, P. E. (2014). Association between the vaginal microbiota, menopause status and
signs of vulvovaginal atrophy. Menopause (New York, N.Y.), 21(5), 450–458. http://doi.org/10.1097/GME.0b013e3182a4690b
