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Menopause and vaginal dryness

Throughout the menopause, the decline of the hormone oestrogen can cause a variety of physical changes in the body, and a range of symptoms and side effects. One of the most dreaded is vaginal dryness – an intimate skin issue that can really impact your quality of life.
Less oestrogen causes the vaginal walls and the lining of the vagina to become much drier, thinner and less flexible. The reduction of vaginal secretions and natural lubrication means the vagina can be easily irritated, and become sore and inflamed. It’s important to recognise and manage menopause vaginal dryness, also known as vaginal atrophy, as it can cause extreme discomfort. If you’re experiencing any of these symptoms – we know how tough it can be and we salute you!
If you are suffering from vaginal atrophy as a result of the menopause, you’re far from alone. Keep reading and discover how to manage vaginal dryness symptoms through the menopause and beyond.

Changes to the vagina during menopause

The perimenopause and menopause can affect the way your vagina looks, feels and functions. In medical terms, this is known as genitourinary syndrome of menopause (GSM). Changes to your most intimate region can leave you feeling completely out of sorts, so understanding how to tackle the specific symptoms is key. 
GSM can cause many different symptoms including vaginal dryness, itching, bladder issues, urinary tract infections (UTIs) and more. Unlike other menopausal symptoms such as hot flushes, vaginal health issues rarely get better of their own accord. Many women are reluctant to speak to a doctor about vaginal dryness problems due to embarrassment and social stigma, but it’s important to seek the right course of treatment, or these uncomfortable and irritating symptoms can persist. Getting over any embarrassment could make a serious difference to your life.
While vaginal changes do not affect all women, they are very common, and can affect the individual emotionally too. This is because vaginal dryness can detract from the enjoyment of sex, interfere with relationships and work, and have a negative effect on day-to-day life and sleep – a whole bunch of reasons to tackle the issue as early as possible!
Fortunately, there are medications and lifestyle changes that can be made to alleviate vaginal atrophy symptoms, allowing you to retain your comfort and self-esteem.
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Dealing with incontinence

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Vaginal dryness/atrophy symptoms

Every woman will experience the perimenopause and menopause differently. Some individuals may experience a range of different vaginal atrophy symptoms, while others might only experience mild discomfort for a short period of time. The following symptoms can range from mild to severe, so treatment should be adjusted accordingly.
Vaginal pain and soreness
The vagina’s rugal folds (the wrinkly tissue that forms the wall of the vagina) allow it to expand for sexual intercourse and childbirth. During the menopause, these rugal folds thin and flatten due to a reduction of oestrogen. The thinning of the rugal folds can cause vaginal pain and soreness, most commonly during sex.
Vaginal dryness
Along with the thinning of the rugal folds, the menopause causes the shortening and narrowing of the vaginal canal. As such, you pay experience vaginal dryness, even when aroused. Lack of natural lubrication can make sex more difficult and painful, and can also make the vagina and vulva more susceptible to tears and injury.
Loss of vaginal sensitivity
During the perimenopause and menopause, the pelvic floor muscles can weaken, which can cause a loss of vaginal sensitivity. With less oestrogen in the body, the clitoris can also lose sensitivity, making sex less enjoyable.
Urinary incontinence
Closely linked to loss of vaginal sensation, urinary incontinence is another common side effect of the menopause. This is because weak pelvic floor muscles promote urinary incontinence. Menopausal women may find they release a small amount of urine when coughing, sneezing, during exercise and other moments. Kegel exercises and TENA pads can help mitigate this widespread issue.
Yeast infections and Urinary Tract Infections (UTIs)
Hormonal changes during the menopause can disrupt the vaginal microbiome, particularly lactobacilli, which helps keep the pH of the vagina balanced. This can result in frequent or severe yeast infections. Additionally, the decline of oestrogen deficiency may be associated with lower urinary tract symptoms such as frequency, urgency, nocturia, urgency incontinence and recurrent infections.

Vaginal dryness/atrophy treatment

If you are going through the perimenopause or menopause, you don’t have to simply put up with the discomfort of vaginal atrophy and its related symptoms. There are many different prescribed treatment options, home remedies and specialist products designed to alleviate menopausal side effects and support you through this time.
Hormone Replacement Therapy (HRT)
Many women choose to start Hormone Replacement Therapy (HRT) to minimise menopausal symptoms, including vaginal atrophy. You can typically begin HRT as soon as you experience menopausal symptoms, after speaking to your doctor. Your doctor will explain the different types of HRT available, and will help you choose the right treatment. You may start on a low dose, which can increase at a later stage as symptoms get more severe.
Over the counter moisturisers and lubricants
Easily accessible over the counter vaginal moisturisers and lubricants are generally the first remedy women try when experiencing vaginal dryness due to the menopause. You can speak to your pharmacist about the most suitable product to restore moisture to the vaginal area and reduce discomfort.
Topical oestrogen creams and pessaries
If over the counter products do not provide you with any relief from vaginal atrophy and you are reluctant to start HRT, your doctor may prescribe an oestrogen cream or pessary. You can apply creams topically to the vulva or insert them internally into the vagina with an applicator. If you are using a pessary, your doctor will let you know how often to insert the tablet to minimise your vaginal dryness symptoms.
Vaginal dilators
If you experience vaginal pain and discomfort during the menopause, you might like to try using a vaginal dilator, a machine that helps stimulate and stretch the vaginal muscles. This can help reduce the narrowing of the vagina due to a reduction in oestrogen. Vaginal dilators can be especially useful for those experiencing pain during sex. These are often available without prescription.
Kegel exercises
Women experiencing the perimenopause and menopause should make a conscious effort to complete regular pelvic floor exercises, otherwise known as Kegel exercises. This will increase blood flow to the vagina, increase elasticity and reduce the likelihood of vagina atrophy.
TENA incontinence pads and products
If you experience urinary incontinence as a side effect of vaginal atrophy, there are plenty of products designed to help you live a full life free of worry and embarrassment. TENA pads can help keep you deal with urinary incontinence by keeping you protected throughout the day, ensuring you can continue doing the things you love during and after the menopause.
The arrival of menopause can feel like significant life upheaval – not least if you are experiencing menopausal incontinence. If you feel that you need additional help and support for vaginal dryness or any other issues, don’t hesitate to contact a professional such as your nearest GP.

Further reading