Menopause is a time of enormous transition, when the chemical rhythms to which your body has become accustomed are upended. That this is a normal, natural process doesn’t diminish how disorienting it can be. And while the changes that come with menopause aren’t necessarily negative, not understanding the changes could lead you to accept conditions that aren’t healthy.
This is especially true when it comes to the sexual effects of hormonal transition. Because the sexual lives of menopausal women often remain poorly misunderstood and shrouded in taboo, too many women accept the pain and discomfort of vaginal dryness as the price of getting older. But it doesn’t have to be.
Vaginal dryness is a serious medical condition that can have multiple social, physical, and emotional ramifications. It’s also highly treatable. By recognizing your symptoms and seeking out the best treatment for vaginal dryness, you can protect your health and overall well-being during this transformative stage of life.
Insights Into Vaginal Dryness
Here are a few sobering statistics: according to a 2018 study, up to 50-60% of postmenopausal women suffer from vaginal dryness, but only about 25% ever report their symptoms to their doctor or seek help. As the authors note:
Many patients are embarrassed to discuss intimate complaints with a specialist, which makes it difficult to verify the diagnosis in 75% of cases, and some patients regard the symptoms of VVA as manifestations of the natural aging process and do not seek help.
The last part is revealing, but not surprising. In our culture, we’re too often told that that aging equals the end of sexual viability. That’s not true, of course, but it’s a powerful and pervasive myth that leads many women to regard vaginal dryness as an inevitable end-point rather than a treatable symptom.
There is also the problem of nomenclature. Currently, menopause-related vaginal dryness is typically attributed to vaginal atrophy. However, the term “vaginal atrophy” may not fully capture the broad range of symptoms that women experience and, as such, may serve to inadvertently act as a barrier to women understanding their bodily experiences. To correct this, the North American Menopausal Society (NAMS) has proposed changing the name of the condition to genitourinary syndrome of menopause (GSM). This all-encompassing term is designed to more accurately describe the “changes to labia majora/minora, clitoris, vestibule/introitus, vagina, urethra and bladder” that are associated with “a decrease in estrogen and other sex steroids.” By reframing symptoms in this context, it may be possible to lift the epidemic of silence that surrounds vaginal dryness.
Causes and Symptoms of Vaginal Dryness
So how exactly do the hormonal changes that cause menopause result in vaginal dryness? As NAMS notes, the decrease in estrogen plays a pivotal role, but progesterone and testosterone can also have a significant impact on vaginal functions. More specifically, low estrogen and disproportionately high progesterone have the effect of thinning the vaginal wall while falling testosterone levels lower sexual sensitivity. Combined, this throws off the ability of the vagina to self-lubricate and can lead to a broad spectrum of symptoms.
Risks and Symptoms of Vaginal Dryness
There are first-order and second-order risks of vaginal dryness. The first-order risks are very straightforward:
- Lack of sexual lubrication
- Sexual discomfort/pain
- Impaired sexual functions
- Urinary urgency
These can all be deeply disruptive, and you should talk to a health care professional if you are suffering from any of these symptoms. But there are also a number of secondary risks deriving from these primary symptoms.
One of the most important second-order risks is that, during your reproductive years, your vaginal secretions possess an acidic pH balance that helps fight off bacteria. Without this, you are at higher risk of urinary tract infections and yeast infections. These are both unpleasant and potentially dangerous. Additionally, vaginal dryness can have a significant effect on your emotional and social well-being. Not being able to experience pleasurable intimacy can be disorienting and troubling. And feeling as if your body no longer responds the way you want can deeply damage your sense of self.
But none of this is inevitable.
Finding the Best Treatment for Vaginal Dryness
When considering treatment for vaginal dryness, the first thing many women ask is, “Why can’t I just use lubricants?” The truth is that lubricants can be helpful for sex and general comfort. But they are ultimately short-term solutions that don’t address the underlying cause of vaginal dryness. Additionally, they won’t provide that important pH balance that protects you from infection and may actually have negative effects on your vaginal tissues; many women find that lubricants trigger yeast and urinary tract infections.
For long-term, durable relief from symptoms, hormone replacement therapy (HRT) is often considered the best treatment for vaginal dryness. In fact, while HRT can address a wide range of menopause symptoms, it has been found to be particularly effective for vaginal dryness and other symptoms of GMS. As Dr. Shirin Khanjani of the Institute of Reproductive and Developmental Biology writes, when taken systemically, “[t]he rise in serum estradiol levels stimulates revascularization and regeneration of the collagen of vaginal and lower urinary tract epithelium.” However, HRT can also be used locally or as combined systemic/local therapy with great results. According to the aforementioned 2018 study, “systemic HRT eliminates the symptoms of vaginal atrophy in 75% of cases, while local therapy does so in 80-90% of cases.”
By connecting to a practitioner who specializes in hormone replacement therapy, you can ensure that you receive the right care for your symptoms and develop a treatment plan that will produce long-term results. What are these results? Restored vaginal function. Restored vaginal comfort. Restored desire. A restored life.
Vaginal dryness isn’t the end. It’s not inevitable, nor is it permanent. It also shouldn’t be a source of shame. With hormone replacement therapy, vaginal dryness and other GMS symptoms can be addressed and you can give your body the chance to heal.
If you are considering hormone therapy to treat vaginal dryness, BodyLogicMD can help. The BodyLogicMD network is comprised of top medical professionals specializing in hormone health and hormone replacement therapy. A BodyLogicMD-affiliated practitioner will design a personalized treatment plan to address your symptoms and help you achieve your health goals using the best therapies available today. Contact a local practitioner to schedule your first appointment, or take the BodyLogicMD Hormone Balance Quiz today.
Disclaimer: These statements have not been evaluated by the Food and Drug Administration. All content on this website is for informational purposes only. The content is not intended to diagnose, treat, cure or prevent diseases.
Charlotte is a patient care coordinator specializing in bioidentical hormone replacement therapy. She is committed to helping patients who struggle with the symptoms of hormonal change and imbalance explore their treatment options and develop effective strategies to optimize wellness.