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Vaginal health during menopause

Lankenau Medical Center August 23, 2011 By Beverly Vaughn, MD

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.

Common symptoms

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 concerns.

Avoiding dryness

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®.

Prescription treatments

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 Menopause and You, 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 health care provider with your specific concerns and questions.

To speak with our nurse counselor, call 1.888.876.8764 or email whs@mlhs.org.

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