Some of you know that menopause can bring some not-so-fun surprises to your lady bits. Yup, it's not just your regular vaginal irritation and it’s not just hit flashes and night sweats – we're talking a whole package deal of changes! Turns out, the hormonal rollercoaster of perimenopause and menopause isn't just messing with your mood; it's having a field day with your vulvovaginal health.
Enter vulvovaginal atrophy – a term for what happens when estrogen starts decreasing on its own as a natural progression of aging or if you were induced into menopause because of cancer treatment, Oophorectomy, hormonal therapy for gender transition, endometriosis treatment, and severe menstrual symptoms, to name a few – about 50% of menopausal women are in on this.1 So, let's get real and dive into the nitty-gritty of how those hormonal shifts are giving your vulva and vagina a run for their money. Plus, I've got some tricks up my sleeve (well, not literally) to help you reclaim that comfort zone. Let's make your lady bits feel fabulous again!
Vulva vs. Vagina: What's the Difference?
Although it's frequently common to use the terms vulva and vagina interchangeably, it's essential to recognize that these are distinct parts of the body. Consequently, they may undergo distinct symptoms during perimenopause and menopause.
The vulva constitutes the external region of the female genitals, encompassing the vaginal opening, the urethral opening (where urine is expelled), the labia, the clitoris, the perineum (the region between the vaginal and anal openings), and the mons (the fleshy mound of tissue over the pubic bone).
The vagina is the internal canal of the female genitals. A long, stretchy tube, the vagina connects the vulva to the cervix. The vagina is where penetrative sex occurs, and it's also the place through which menstrual blood exits the body.2
In the course of perimenopause and menopause, numerous women undergo alterations in both vulvar and vaginal tissues, which may lead to discomfort and potentially elevate the risk of infection.
Vulvar Changes in Menopause
Perimenopause and menopause usher in a significant decline in estrogen levels, leading to the thinning, drying, and heightened susceptibility to irritation of external vulvar tissues. Consequently, discomfort or a stinging sensation, particularly during sexual activity, becomes more prevalent. Changes in the appearance of the vulva are also noticeable. Many women observe a pale or shiny quality in the skin on the outside of their genitals. If irritation occurs, the vulvar tissues may display redness or exhibit petechiae - small, purple-brown bumps resulting from inflammation-induced bleeding under the skin. Additionally, the labia may appear flatter and less plump.
Vaginal Changes in Menopause
The hormonal changes that impact the vulva frequently extend to the vagina as well. Diminished estrogen levels can lead to thinning, dryness, increased tightness, and heightened vulnerability to inflammation in both the vaginal walls and the vulva. Simultaneously, the vaginal pH undergoes a decrease in acidity, contributing to a depletion and imbalance of beneficial bacteria.3
Together, these changes can lead to symptoms like burning, itching or irritation, painful sex, changes in vaginal discharge, as well as pain during urination or having to urinate more often.4 This drop in good bacteria, too, can set the stage for more frequent vaginal infections, including BV (bacterial vaginosis) and yeast infections.5
Numerous women often incorrectly perceive the vulvar and vaginal discomfort emerging during menopause as a typical aspect of aging – a condition they assume is unavoidable. However, these symptoms are indicative of a prevalent condition known as vulvovaginal atrophy (also referred to as genitourinary syndrome of menopause (GSM), vaginal atrophy, or atrophic vaginitis). While prevention may not always be possible, effective management strategies exist.6
Managing Vulvar and Vaginal Discomfort in Menopause
- If experiencing vulvovaginal irritation, it's crucial to discuss it with your healthcare provider.
- Hormone changes during menopause can contribute to discomfort, but other factors may be involved.
- A thorough examination and discussion with your provider can help identify the root cause and rule out other health issues.
- Managing vulvar and vaginal symptoms related to menopause often requires a comprehensive approach.
- Explore treatment options with your provider, including lifestyle changes and supplements.
- Vaginal moisturizers or lubricants can be effective in restoring moisture and enhancing comfort during sex.
- Regular sexual activity, whether solo or partnered, can positively impact vaginal health.
- Avoiding sex after menopause may lead to the vagina becoming shorter and narrower, causing potential discomfort.
- Regular sexual activity promotes healthy blood flow to vaginal tissues, maintaining elasticity and lubrication for more comfortable intimacy.
- Understand that vulvar and vaginal changes during menopause are common.
- Work collaboratively with your healthcare provider to find tailored solutions that address your specific needs and ensure your comfort during this life stage.
Managing Vulvar and Vaginal Discomfort in Medical or Surgical Menopause
Experiencing medical or surgical menopause can bring about various changes, especially in the realm of vaginal health. Understanding and addressing these changes is crucial for maintaining overall well-being. In this blog post, we'll explore some practical suggestions to help you navigate and embrace the transformations in your vaginal health during this unique phase.
Open Communication with Healthcare Providers:
- Regularly communicate with your healthcare provider about any concerns or changes you may be experiencing.
- Schedule routine check-ups to monitor your overall vaginal health and discuss any symptoms.
Educate Yourself on Vaginal Changes:
- Stay informed about the common vaginal changes associated with menopause, such as dryness, thinning of vaginal walls, and changes in pH levels.
- Understand the impact of hormonal shifts and how they contribute to these changes.
Consider Hormone Therapy Options:
- Discuss hormone therapy with your healthcare provider to determine if it's a suitable option for managing vaginal symptoms. For instance, Suzanne our Founder has ER+ HER2- breast cancer and is not allowed to take HRT because her estrogen was feeding her cancer.
- Explore the potential benefits and risks associated with hormone replacement therapy (HRT).
Vaginal Moisturizers and Lubricants:
- Incorporate vaginal moisturizers and lubricants into your routine to alleviate dryness and discomfort.
- Experiment with different products to find the one that works best for you.
Maintain Sexual Health:
- Engage in regular sexual activity to promote healthy blood flow to the vaginal tissues.
- Communicate openly with your partner about any changes in libido or preferences.
Pelvic Floor Exercises:
- Consider incorporating pelvic floor exercises (Kegel exercises) into your routine to help strengthen pelvic muscles.
- Consult with a healthcare professional or a pelvic health physiotherapist for personalized guidance.
Diet and Hydration:
- Stay hydrated, as proper hydration supports overall vaginal health.
- Include foods rich in omega-3 fatty acids, antioxidants, and vitamin E to promote tissue health.
- Be mindful of potential irritants, such as scented products or harsh soaps, that can exacerbate vaginal discomfort.
- Opt for gentle, fragrance-free hygiene products.
Embracing the changes in vaginal health during menopause involves a holistic approach that encompasses communication with healthcare providers, education, and self-care practices. By staying proactive and informed, you can navigate this phase with confidence, prioritizing your overall well-being and embracing the journey of menopause.