Guest Blog: Dr Louise Newson on managing menopausal vaginal dryness
Many of my female patients are very comfortable talking to be about their hot flushes and night sweats. However, even the ones I have known for many years are often really reserved and not forthcoming when talking about their dry vaginas!
Understandably, women are usually embarrassed and do not realise how common vaginal dryness is. They feel uncomfortable talking about their symptoms and usually I am the first person they have even spoken to about how their symptoms are affecting them. Vaginal dryness or atrophy is also called atrophic vaginitis. Some doctors refer to it as genitourinary syndrome of the menopause (GSM) as it is not just your vagina that is affected. The low levels of oestrogen in your body can lead to thinning and weakening of the tissues around the neck of your bladder, or around the opening for urine to pass (the urethra). For example, urinary symptoms that may occur include an urgency to get to the toilet and recurring urinary infections or cystitis. Once women talk openly about their symptoms, I find vaginal dryness really rewarding to treat. Prescribing the right treatments can make a huge difference to the woman and also to their partner.
Taking HRT systemically (tablets, gel or patches) can also improve these symptoms. However, some women who take HRT need these local treatments in addition to relieve these symptoms. It is completely safe to use vaginal oestrogen with HRT. There are really effective treatments available. Often one of the first treatments I recommend is replacing the oestrogen in your vagina and the surrounding tissues. A cream, vaginal tablet or ring containing oestrogen is often prescribed and they work really well. A vaginal tablet is a very small tablet that you insert into your vagina with a small applicator. The vaginal tablets and creams are usually used every day for two weeks, and then used twice a week thereafter. The ring is a soft, flexible ring with a centre that contains the oestrogen hormone. This ring releases a steady, low dose of oestrogen each day and it lasts for three months. It can be inserted and replaced easily by yourself, or by your nurse or doctor. Using topical oestrogen in this way is not the same as taking HRT and therefore does not have the same risks associated with it. This is because these preparations work to restore oestrogen to your vagina and surrounding tissues without giving oestrogen to your whole body. These preparations can be safely used by most women and also can be used on a regular basis over a long period of time (usually indefinitely) as your symptoms will usually return if you stop this treatment. Vaginal lubricants and moisturisers can be used either with hormones or on their own and are usually also extremely effective. Many women use a combination of topical oestrogen and moisturisers/lubricants. This is both very effective and safe. Although some are available on prescription from your doctor there are many more that can be bought from various chemists or from the manufacturers directly.
There are many different products available and it is important that you find one (or a combination) that suits you. Moisturisers are used regularly whereas lubricants are usually used during sexual intercourse. It is important to find a moisturiser and lubricant which are free from skin irritants. Some lubricants may cause irritation, so if you have very sensitive skin, an alternative product may be preferable. The osmolality of a lubricant is also important as if they are hyper-osmolar then this can lead to drying, irritation and worsening of symptoms. Every woman is different and so it is so important to find a product that you feel comfortable with. Whichever method you decide on to treat your vaginal dryness, the great advantage is that, very often, your sex life will be re-invigorated as a result of your treatment!