It comes as no surprise to women in menopause that many parts of their
bodies exhibit changes. The hormones that were plentiful in the
reproductive years have diminished. The areas of the body that depended
on those hormones for health now function differently without them.
Not all women are subject to the same differences. Not all changes occur
at the same point in menopause.
Lower Levels of Estrogen Cause Differences in the Vagina
There are molecules in the vagina known as receptors. Estrogen fits into
these receptors like a key. It is through this mechanism that estrogen
has its action. Vaginal health is dependent on estrogen to provide
elasticity and thickness to the tissue. This includes the vulva or lips.
It is also necessary to provide blood flow and moisture. Estrogen plays
an important role in maintaining the chemical balance, or pH. As
estrogen falls, the pH rises, and this can make women more
susceptible to vaginal infections.
The most common symptom of reduced vaginal estrogen is dryness. Women
notice this in two ways. The vaginal area can feel dry and irritated.
Many times women seek medical attention, believing that the irritation
is related to an infection. Sexual intercourse can become uncomfortable
because the diminished blood flow inhibits lubrication. Intimate
relations can gradually become less pleasurable and possibly less
frequent. Another alteration is that the actual structure of the vagina
is not the same. The external parts of the genitalia, the vulva and the
clitoris, become thinner. This is not only a change seen on the surface
but in the underlying tissue as well, which loses some of its fat and
collagen. The length of the vagina shortens and the diameter narrows.
Women often find these new physical facts of life not only
uncomfortable, but distressing. These changes are easily managed and do
not have to be permanent. There are several ways to address these
It is important to remember that the skin of the genital area is
sensitive. Using harsh deodorant soaps or body washes will dry the skin
further and cause more itching. Douching can also cause irritation. It
is best to avoid these products.
There are numerous over-the-counter products to help alleviate dryness.
Moisturizers can be used for day-to-day dryness that causes a feeling of
burning or itching. Replens® is one example. Dryness that is associated
with intercourse can be managed with water-based or silicone-based
lubricants such as Slippery Stuff® or Astroglide X®.
Oral estrogen and estrogen patches are beneficial for hot-flash relief,
but they do not always provide adequate relief for vaginal complaints.
It is not unusual to require local application of estrogen in addition
to systemic hormone therapy. The Women's Health Initiative study voiced
concerns about the safety of traditional estrogen. The good news is that
this does not apply to vaginal therapy. Very little estrogen placed
vaginally circulates throughout the body. In fact, after using vaginal
estrogen for a short period of time the absorption decreases as the
walls of the vagina thicken. Women who do not want to take systemic
estrogen can use local estrogen by itself. Vaginal estrogen comes in
several forms. The oldest is a cream usually used twice a week. Newer
preparations include a tablet, also used twice a week, and a ring that
is placed for 12 weeks at a time. The choice is up to the individual and
what she feels will be the most preferable. Some physicians feel that
even though the level of estrogen in the body is low with these
therapies, the uterine lining may be stimulated.
There is a new product Osphena® which is designed specifically to treat
vaginal dryness. It is a pill taken by mouth daily. It has a structure
similar to estrogen but it is not an estrogen. It cannot be taken if you
are taking estrogen for hot flashes or using an estrogen vaginally.
Remember whichever option you choose, it will take a few weeks to notice
results. Vaginal dryness tends to return if you stop your treatment.
This article is part of the Menopause and You library,
a Web-based program sponsored by Women’s Health Source.
It is intended as an information resource providing guidelines for
women. As always, check with your own healthcare practitioner with your
specific concerns and questions.
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