What Your Mother (and probably your doctor) Didn’t Tell You About Your Vagina & Menopause
When we think of menopause, we typically think of things like hot flashes, night sweats, poor sleep, and mood changes. And while these are certainly bothersome symptoms, they tend to eventually go away in most women. What doesn’t go away, and even tends to worsen over time, is something called Genitourinary Syndrome of Menopause (GSM). GSM encompasses a range of symptoms, including vaginal dryness, irritation, burning, painful intercourse, recurrent urinary tract infections, and urinary urgency or incontinence. Approximately 50%-70% of postmenopausal women are affected by GSM; however, many cases go undiagnosed and untreated because women may not seek help or may not associate their symptoms with menopause.
The tissues in the vagina and the vulva (the outside parts including the labia, clitoris and urethra) are very dependent on hormones, specifically estrogen and testosterone. Estrogen helps maintain the thickness, elasticity, and resilience of vaginal and vulvar tissues. When estrogen levels decline, the vaginal epithelium (lining) becomes thinner, more fragile, and prone to irritation and tearing. Furthermore, the vulvar skin loses collagen and fat, leading to shrinkage and increased sensitivity (and not the good kind!). Because estrogen stimulates mucus production in the vaginal walls to keep this tissue moist, vaginal dryness and discomfort during intercourse can occur without it. Estrogen also maintains an acidic pH in the vagina, which supports beneficial Lactobacillus bacteria that helps to prevent infections. With estrogen loss, the pH becomes more alkaline, thereby increasing the risk of vaginal infections (bacterial vaginosis, yeast infections) and urinary tract infections (UTIs).
The urethra and bladder also have estrogen receptors. When estrogen declines, these tissues weaken, leading to increased urinary urgency, frequency, incontinence, and recurrent UTI’s due to a weaker urethral closure mechanism. Over time, the clitoris and labia minora may shrink and become less sensitive, leading to decreased sexual arousal and orgasmic response.
The good news is that these physical changes in the vagina and vulva that are caused by the loss of estrogen do not need to occur. Vaginal estrogen is a highly effective and very safe treatment for GSM. It is a low-dose, localized form of estrogen that primarily acts on the vaginal and urinary tissues. Because of the abundance of estrogen receptors in these tissues, the estrogen molecules are pulled in locally and do not get systemically absorbed. Research and expert consensus strongly support the safety of vaginal estrogen, and there are very few women who would not be candidates for it’s use. Studies show that low-dose vaginal estrogen does not increase the risk of breast cancer, does not affect the endometrium (or lining) of the uterus, and does not increase the risk of blood clots, stroke, or heart disease. The North American Menopause Society (NAMS) and the American College of Obstetricians and Gynecologists (ACOG) acknowledge that in some cases, the benefits may outweigh the risks, even in breast cancer survivors (of course, it is always recommended to discuss this complex issue with your healthcare provider).
The benefits of vaginal estrogen go beyond just relieving dryness.
It can:
Improve vaginal elasticity and lubrication, making intercourse more comfortable
Reduce the risk of recurrent urinary tract infections (UTIs) by up to 50%
Improve the strength of vaginal and urethral tissues, reducing urinary urgency and incontinence symptoms
Enhance overall vaginal health and quality of life
Final thoughts:
Vaginal health is important for every woman, regardless of sexual activity. Vaginal estrogen is a safe and effective treatment for vaginal and urinary symptoms of menopause. It is available in a variety of options, including creams (most effective for vulvar tissue), insertable tablets or ovules, rings, or suppositories. Ladies, we moisturize and take care of the sensitive skin on our face, why not put as much love into the sensitive tissue of our vagina and vulva?
Would you like additional support in navigating your sexual health concerns? Book an appointment with me for personalized guidance on menopause management.