During menopause, estrogen production slows and then stops. When that happens, a number of changes -- many of them unwelcome -- happen in a woman's body. Periods become irregular and then stop. You may have hot flashes, mood swings, a deeper voice, and an increase in facial hair.
Vaginal dryness is another common symptom of menopause -- and close to one out of every three women experiences it while going through "the change." And it becomes even more common after menopause. Vaginal dryness also can occur at any age from a number of different causes. It may seem like a minor irritation. But the lack of vaginal moisture can have a huge impact on your sex life. Fortunately, several treatments are available to relieve vaginal dryness.
What causes vaginal dryness?
Normally, the walls of the vagina stay lubricated with a thin layer of clear fluid. The hormone estrogen helps maintain that fluid and keeps the lining of the vagina healthy, thick, and elastic. During menopause, the drop in estrogen levels reduces the amount of moisture available. It also makes the vagina thinner and less elastic. This is called vaginal atrophy.
In addition to menopause, estrogen levels can drop from:
- Childbirth and breastfeeding
- Radiation or chemotherapy treatment for cancer
- Surgical removal of the ovaries
- Anti-estrogen medications used to treat uterine fibroids or endometriosis
Other causes of vaginal dryness include:
- Sjögren's syndrome (an autoimmune disorder that attacks cells in the body that produce moisture)
- Allergy and cold medications and certain antidepressants
- Lack of enough foreplay before sexual intercourse
No matter what the cause, vaginal dryness can be extremely uncomfortable. It can lead to itching, burning, and painful intercourse.
How is vaginal dryness diagnosed?
Any burning, itching, or discomfort in the vaginal area warrants a call to your doctor or gynecologist. The doctor will take a health history and find out how long you've been experiencing symptoms and whether anything -- such as douching or taking medication -- seems to worsen them.
Your doctor will then do a pelvic exam, checking your vagina for any thinning or redness. The exam will help rule out other possible causes for your discomfort, including a urinary tract infection. The doctor may also do a Pap test to remove and test cells from your vaginal wall or cervix.
How is vaginal dryness treated?
The most common treatment for vaginal dryness due to low estrogen levels is topical estrogen therapy. Topical estrogen replaces some of the hormone your body is no longer making. That helps relieve vaginal symptoms, but it doesn't put as much estrogen in your bloodstream as oral estrogen hormone therapy (HT).
Most women use one of three types of vaginal estrogen:
- Vaginal estrogen ring (Estring). You or your doctor inserts this soft, flexible ring into the vagina. There it releases a steady stream of estrogen directly to the vaginal tissues. The ring is replaced every three months.
- Vaginal estrogen tablet (Vagifem). You use a disposable applicator to insert a tablet into your vagina once a day for the first two weeks of treatment. Then you insert it twice a week until you no longer need it.
- Vaginal estrogen cream (Estrace, Premarin). You use an applicator to insert the cream into your vagina. You will typically apply the cream daily for one to two weeks then reduce the frequency to one to three times a week as directed by your doctor.
- Have breast cancer, especially if they are taking an aromatase inhibitor
- To women with a history of endometrial cancer
- To women who have undiagnosed vaginal bleeding
- To pregnant or breastfeeding women
There isn't much research on the long-term use of topical estrogen, but doctors believe it is safe to use in the long term.
In order to keep the vagina more lubricated, try using a vaginal moisturizer (Replens, Lubrin), which you can buy at your local drugstore or supermarket. You can make intercourse more enjoyable by applying a water-based lubricant (Astroglide, K-Y) beforehand. Also take your time before having sex to make sure that you are fully relaxed and aroused.
Avoid using douches, bubble baths, scented soaps, and lotions around the sensitive vaginal area. These products can worsen dryness.