Menopause results in a number of bodily changes – particularly to your vagina.
Menopause is a fact of life…
It happens to all women. Sometimes menopause is a result of surgery (hysterectomy and oophorectomy), chemotherapy, or as part of natural ageing. As we get older (from about 42 years of age) the number of eggs we have stored in our ovaries declines. This results in lower levels of oestrogen circulating through the body. These lower levels of oestrogen can affect the vagina in a number of ways.
Up to 50% of women of menopausal age will report symptoms such as irritation, dryness, itching or a ‘sandpaper like feeling’ during sex. There can be problems with decreased sexual responsiveness (sexual touch doesn’t feel as good, or it hurts) and consequently lower libido (who’d want to have sex if it hurts?).
The delicate tissue of the vagina needs oestrogen to keep it healthy; oestrogen keeps the walls of the vaginal tissue strong and stretchy, as well as maintaining the amount of, and pH balance of the secretions. The secretions – the normal discharge of the vagina – help to provide a physical and chemical barrier to infections as well as maintaining vaginal comfort.
But it’s not just the vagina that is affected…
Our pelvic floor (the muscles around the vagina and anus) and urinary system (bladder and urethra) can suffer too. Oestrogen helps to maintain the strength in the pelvic floor muscles and the bladder – so declining oestrogen can result in urinary leakage with coughing, jumping or when your bladder is full. Women are also more likely to experience urinary tract infections.
We call all of these problems: Genito-urinary Syndrome of the Menopause (GUSM). Doctors used to call this condition ‘atrophic vaginitis’.
While some menopausal symptoms, like hot flushes, decrease with time, GUSM tends to get worse.
What can we do?
Thankfully, quite a lot!
- Firstly: don’t ignore vaginal and vulval symptoms and assume that ‘it’s just thrush’. See a doctor!
- Secondly: don’t wash with soaps, have bubble baths, use sprays, douches or anything perfumed. Water is just fine and soap alternatives for the mons pubis and around your bottom are OK.
- Thirdly: cotton undies are best. Avoid tight fitting pantyhose, G-strings, staying in wet gym wear and bathers.
- Fourthly: use a lubricant for sex. You’ll need a water or silicon based lubricant if you are using condoms. Olive and Bee Intimate Cream is best and can be used as a vaginal treatment. I like to call it the ‘downstairs chapstick’!
- Finally: talk to an expert about vaginal oestrogen replacement and the best regimen for you. The amount of oestrogen absorbed into the blood stream with regular use of vaginal oestrogen is very, very, very low.
You might need vaginal oestrogen more often than the standard twice a week. You might do better with a combination of cream and a pessary (tablet that goes inside the vagina) supplemented by daily moisturisers like Dermeze or Vitamin E cream.
Further reading: Contraception needs during Perimenopause
Dr Tonia Mezzini has been helping women with vaginal concerns for years. If you think that you may have GUSM, make an appointment to see Dr Tonia Mezzini today.
Dr Tonia Mezzini is known for offering the best possible advice and treatment options for a person’s sexual health care needs. In particular, she cares for patients with:
- Vulval pain syndromes and vulval skin conditions
- Low libido and pain with intercourse
- Polycystic Ovarian Syndrome
- Gender-affirming hormone therapy
- Complex contraceptive choices
- Sexually transmitted infections such as recurrent genital herpes
- Recurrent bacterial vaginosis
- Recurrent thrush
- Menopause and hormonal concerns
- Chronic pelvic pain in men and women
- Painful periods and endometriosis