Vaginal atrophy is due to reduced oestrogen levels; as the vaginal walls become thinner, drier, less elastic and more fragile, they may become inflamed. The vaginal canal itself may become shorter and tighter. This can result in burning or itching of the vagina or vulva, leading to pain during intercourse and blood-spotting after intercourse. As these symptoms typically occur later rather than at menopause they are often attributed to ageing rather than oestrogen.
A further consequence is that women with vaginal atrophy have a greater chance of recurrent vaginal infections and urinary function problems, including the need to urinate more frequently and urinary incontinence. A new umbrella term has been devised to cover all these issues - GUS (genito-urinary syndrome of the menopause).
Main symptom dryness and discomfort with intercourse: first try over-the-counter remedies (mainly lubricants and moisturisers at the pharmacist.
- Lubricants are good for short term relief from dryness, and are available as either water-based or oil-based products.
# Sylk = a water-based lubricant derived from kiwi plant vines. Hormone and paraben free and safe to use with condoms and sex toys.
# Yes = available in both water and oil-based types. Oil-based possibly longer lasting but not for use with condoms. Both certified organic and available with and without applicators. - Re-moisturisers plump up the tissues and may make you less vulnerable to recurrent infections.
# Replens and Regelle claim to last for up to 72 hours by adhering to dry cells and offering continuous moisture.
# Hyalofemme contains hyaluronic acid, a popular ingredient in anti-ageing skin care products. Usually re-applied once every three days.
# Other brands are available including a Boots chemist's own brand version.
- Vagifem = vaginal tablets inserted with an applicator, used daily for the first fortnight, then twice a week. Prescribed by a doctor and contains estradiol, a female sex hormone produced in the ovaries. Is a form of HRT but only the tiniest amount passes into the bloodstream in the initial use period, and is unlikley to do so once the vaginal cells are plumped up. Relieves dryness and itching, may make you less prone to infections and help with problems of urinary frequency.
- Estring = a flexible silicone ring worn in the vagina continuously for three months that releases oestrogen into the vaginal tissues. Should be reviewed annually and not used continuously for more than two years. Can be inserted by you or your doctor.
- Ovestin cream = also release oestrogen directly into the vagina. Can be used around the clitoris to improve sensory awareness.
A systematic review of soy isoflavones, published in the Journal of Obstetrics and Gynaecology, found that they may help alleviate the symptoms.
Sources: features in Lifespan issue Spring 2016 and Linda Kelsey in Good Housekeeping, February 2017
