Vaginal dryness is perhaps the most distressing and least talked about symptom of menopause.
Vaginal dryness probably results from changes that occur when estrogen levels drop. Low estrogen causes the vagina and surrounding connective tissue to lose elasticity and the tissue that lines the vagina becomes thinner and more fragile. Vaginal dryness occurs in about 20% of women, sometimes transiently and other times permanently. If you're sore from vaginal dryness, you don't want to have sex and if you don't have sex, your vaginal dryness gets worse—a classic catch-22.
How does vaginal dryness feel? Itchy is how most women describe it. Vaginal dryness can cause pain and bleeding during intercourse and increase the possibility of developing a vaginal infection.
Like other menopausal symptoms, vaginal dryness is not something you have to accept. There are a number of ways you can counter it. These include:
Sexual exercise—either alone or with a partner—will increase your natural lubrication.
Drinking lots of water can help your whole body, including your vagina, stay hydrated.
There are lubricants that you can use during sexual activity that will make you more slippery. These include K-Y Jelly and Astroglide. There are also products you can use on a regular basis to eliminate vaginal dryness, such as Replens. You can open vitamin E capsules and apply the oil inside your vagina daily for a week or two and then once or twice a week after that.
Herbalists suggest that taking motherwort tincture or dong quai in any form by mouth for three to seven days generally improves vaginal lubrication. Homeopathic remedies suggested include bryony, lycopodium, and belladonna, but there are no good studies to support these recommendations. For more information on these herbal products, try these websites:
- MedlinePlus—Drugs Provides a searchable database on herbs, botanicals, and other products.
- National Center for Complementary and Alternative Medicine Provides extensive information on herbs and other alternative treatments.
- Consumer Reports Medical Guide: Natural Medicine Ratings
- Memorial Sloan-Kettering Cancer Center Provides a searchable database on herbs, botanicals, and other products.
- American Cancer Society's Information on Complementary and Alternative Therapies Provides information about common CAM treatments.
Note to Women with Breast Cancer:
If you have had breast cancer, some of these herbs may not be recommended. You should discuss their use with your physician. You can also find information specific to individuals with cancer on these sites.
Vaginal estrogen can be very effective in treating dryness. There are a number of methods currently available for taking estrogen vaginally. Two options are Premarin cream and Estrace. Both are very well absorbed. Some women think that because you apply the cream only inside your vagina, none of it will get into the rest of your body. This isn't the case. Some of the estrogen is absorbed into your blood. In fact, both Premarin and Estrace raise your blood levels of estrogen much the same as estrogen pills.
You only need a low dose of these products. One study found that a dose of 0.1mg provided effective relief from vaginal dryness. When you start using vaginal cream, you apply a small dab just inside your vagina daily for three or four weeks. Then you can reduce your use to once or twice a week. If you apply it daily for more than four to six weeks, it becomes less effective. It's important to remember that this is not a lubricant. You should use K-Y Jelly or Astroglide or another type of lubricant before having sex.
Easier and less messy are the new sustained release products, Estring and Vagifem. Estring is a low-dose estrogen ring that is placed in the vagina (much like a diaphragm) for three months at a time. It releases small amounts of estradiol over time. The estrogen dose is so low that it is not absorbed into the rest of the body. Newer products like Vagifem involve placing a tablet in the vagina rather than a ring.
Note to Women with Breast Cancer:
Women who have had breast cancer can use Vagifem or Estring. Estrogen cream, such as Estrace is not recommended. Neither is Femring, which is a form of hormone replacement therapy (HRT).