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The menopause may finally liberate you from monthly menstrual periods, but its other symptoms are less pleasant. What can you do about vaginal dryness?

When I first realized my periods were becoming less regular and lighter, I was quite excited — the prospect of never being plagued by periods again seemed like a rather sweet deal. This whole menopause thing got more annoying with time, however, as more symptoms started to emerge.

No more periods — good. Other stuff — bad. The hot flashes, night sweats, and mood swings are temporary, but the vaginal dryness isn't. It may, in fact, get worse with time! What now?

A Refresher Course: What Do You Need To Know About The Menopause?

We're all aware that the menopause marks the end of fertility and the end of periods — the second one sounding like a welcome relief to many women who are quite fed-up with nearly a lifetime of monthly bleeding. You may also have heard that menopause can officially be "diagnosed" when you haven't had a period in 12 months and that this milestone comes along at age 51, on average, in the United States. The average age of menopause varies from country to country, however, and this is affected by socioeconomic, genetic, and environmental factors. [1]

Before you enter the menopause and your ovaries stop producing the hormones estrogen and progesterone, you go through a transitional period — the perimenopause. This transitional phase can drag on for years, and the symptoms you may experience during the perimenopause can be pretty unpleasant:

  • If you're lucky, your periods will become lighter and less frequent. You may also go through phases of having really heavy periods every few weeks, however, and that's not so nice.
  • Hot flashes.
  • Night sweats.
  • Sleeping difficulties.
  • Mood swings.
  • Difficulty concentrating.
  • More hair on your face.
  • Perhaps less hair on your head. [2]

Then, there's vaginal dryness. While most of the other symptoms resolve as you leave the perimenopause behind and find yourself squarely on the other side, vaginal dryness only gets worse [3]. Your vaginal wall becomes thinner, you may experience inflammation, and the pH levels and even your vaginal microbiome undergo serious changes [4]. 

As a result, you may experience significant discomfort — and your sex life may take a hit, too. Why does this happen, and what can you do about it?

Why Does The Menopause Cause Vaginal Dryness?

Research reveals that:

  • Of all post-menopausal women, around half report that they have vaginal dryness they experience as problematic. 
  • A third experience vaginal itching. 
  • Forty percent of sexually active post-menopausal women report pain during intercourse. 
  • Women with diabetes and those with a lower body mass index are particularly likely to experience vaginal dryness after entering the menopause. [5]
  • The prevalence of post-menopausal vaginal dryness varies from country to country. [6]

While numerous studies have found that estrogen replacement therapy lessens women's subjective experience of vaginal dryness — to the point that half of those who originally reported having this issue will be rid of it after starting HRT — it is likely that a lack of estrogen isn't the only reason for vaginal dryness. Diabetes, being underweight, and not being in great physical shape all play a role, along with chronic conditions like vulvovaginal lichen planus and temporary problems like vaginal yeast infections. [5]

What Can I Do About My Post-Menopausal Vaginal Dryness?

Pain or discomfort during intercourse, burning sensations, itching, and even spotting due to small tears in the vaginal wall because of the dryness [7] are all unpleasant. If you're hoping to do everything in your power to rid yourself of vaginal dryness, you have two broad options:

  • Hormone replacement therapy
  • Lifestyle measures

Hormone replacement therapy became less popular with the revelation that it can seriously increase your risk of stroke and heart attack. Though the benefits of HRT may outweigh the risks in certain women, it's certainly understandable if you would prefer to avoid them altogether.

The topical application of estrogen may not carry the same risks systemic hormone replacement therapy does, however, and thankfully there are many options.

Estrace, Neo-Estrone, and Premarin are vaginally applied estrogen creams, while Estring is a vaginal ring that can remain in place for up to three months and Vagifem is administered in the form of vaginal suppositories (tablets). [8]

You may also use non-hormone vaginal creams such as Replens, since they can be just as effective as topical estrogen treatments [9]. Vaginal moisturizers like Moist Again may also help. 

"Lifestyle measures" basically boils down to the use of lubricants during sex, if you've already been to the doctor and non-menopausal causes of vaginal dryness like lichen sclerosus and yeast infections were ruled out. KY jelly can become your best friend — and while it may not be the sexiest thing in the world, your partner may likewise be at an age where assistive techniques (like Viagra and penile pumps) are required for sex. Also avoid douching, which disturbs the vaginal flora and may worsen your symptoms [10]. 

The Bottom Line 

The menopause is just another part of life. Since you'll be liberated from menstrual periods, it ain't all bad, but some parts of the menopause also really suck. If you're constantly plagued by vaginal dryness, itching, and burning — not just when you're having sex — see a doctor. Ask your doctor to rule out non-menopausal causes of vaginal dryness, and discuss the possibility of using estrogen replacement therapy with them as well. 

If your vaginal dryness is merely mildly annoying, see if things improve if you use a lubricant or a non-hormonal vaginal cream and consistently use lubricants during sex.

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