It’s a well-known fact that it’s good to talk. Numerous campaigns tell us so. From mental health to yes, the menopause, we are encouraged to have a chat with health professionals, friends and family. But what if you struggle to put into words your symptoms? That is exactly what happens to many women that suffer from vaginal dryness despite it being one of the most common symptoms of the menopause. Affecting around 55% of women during or after the menopause, dryness (also referred to as the genitourinary syndrome of the menopause or GSM), barely gets mentioned in the list of symptoms women will deal with, whereas hot flushes are synonymous with the mid-life transition.
To put it bluntly, talking about an uncomfortable vagina and vulva is still a taboo, but it is vital to prevent many women suffering in silence and not seeking help until their dryness is so advanced that it can take time to find effective treatment. Yet it doesn’t have to be this way. Finding the right words to describe the problem, arming women with information about treatments and banishing embarrassment from the conversation are the first steps to successfully managing the condition.
Many women first notice the symptoms of vaginal dryness during the perimenopause and menopause, however unlike other symptoms that tend to ease as you go through the transition, the genitourinary symptoms will not get better with time. In fact, they may well get worse as you get older. Caused by declining levels of oestrogen in the body, the tissues around the vagina, vulva and urinary tract become thinner and weaker and therefore more prone to infection and sensitivity. Signs that you are suffering from GSM could include the skin in the area feeling dry, sore, red and itchy, you may find that sex is painful and that tiny paper-like cuts develop on the vulva that take a long time to heal. You might also notice increased frequency and urgency to pass urine and recurrent urinary tract infections.
‘These symptoms can start at anytime during the menopause transition,’ says Dr Juliet Balfour, who is a GP and British Menopause Society-accredited menopause specialist, ‘But often they don’t start until five to ten years after the last period, so women don’t associate the symptoms as being related to the menopause. However, the whole area is very sensitive to lack of oestrogen so often if you’re getting the vulval and vaginal symptoms, you will get the urinary symptoms as well. It’s so important to start treating people as soon as possible, because unlike a lot of menopause symptoms like hot flushes and night sweats that should pass eventually, the problem with GSM is that it is only going to get worse without treatment.’
The main treatment option for vaginal dryness is local oestrogen, which gives tiny amounts of oestrogen directly where it is needed, plumping out the tissues and reducing the risk of infection. And the good news is that it comes in many different forms, including gels, creams, pessaries and a soft silicone ring that is inserted into the vagina and slowly releases low-dose oestrogen over a three-month period. What works well for one woman won’t necessarily suit another, so it is important to work with your GP to find an individual treatment regime. Even if you are already taking systemic HRT, local oestrogen may still be needed long term as well, according to Balfour.
‘Local oestrogen is safe for most women including women who have had oestrogen-dependent cancers with just a few caveats to that. The problem that we, as health professionals have, is that the patient information leaflet inside the local oestrogen packs is the same leaflet that is inside all other forms of HRT. So women will look at it and it will say that this product could give you a heart attack, stroke, blood clot, breast cancer or dementia and understandably that puts women off. But there aren’t any of those risks associated with local oestrogen, it is tiny amounts.’
There are a range of other measures that you can take to reduce some of the effects of vaginal dryness. Just as you would moisturise any other area of your body, then the area surrounding the vagina is no different. An external vaginal moisturiser or oil keeps the tissues well hydrated says menopause specialist Dr Shahzadi Harper, who runs The Harper Clinic in Harley Street, London.
‘Remember to apply it not just on the vagina but to the vulva also and all the way back towards the perineum because a drop in oestrogen affects all of the skin and mucosa around there,’ she advises.
Harper also encourages her patients to consider using a sex toy to improve blood flow and circulation and says it can help women who are struggling with loss of libido and confidence in their body.
‘There are a lot of psychological impacts in how dryness causes patients to feel about themselves. Emotionally it can give rise to anxiety about sex and women can avoid intimacy with their partner.’
Nutrition can also be another piece of the puzzle when approaching GSM symptoms. Anita Beardsley, a nutritional therapist in Bristol, works with many women during the menopause and says, ‘The areas you want to think about supporting are vaginal tissue integrity, the lactobacillus species that resides in the vaginal space and optimising the oestrogen that you are still producing during the menopause transition.’
Her advice for patients with vaginal dryness includes adding fermented foods to your diet such as kimchi, as well as prebiotic foods like onions, garlic and leeks to support the lactobacillus ‘good bacteria’ in the vagina. In addition aim for two dessert spoons of ground flaxseeds a day for optimising oestrogen, and include plenty of zinc-rich foods and a sea buckthorn oil supplement for tissue integrity. She admits that it, ‘can be overwhelming to make changes to your diet,’ but advises women to ‘take small steps, do the best you can and seek professional advice.’
The symptoms of vaginal dryness can leave women feeling very lonely but it doesn’t have to be this way. There are many treatment options to explore, ways to improve symptoms and support the tissues so that it is possible to live a full life. However, none of this is possible if we don’t break down some of the barriers and stigma associated with GSM. It’s a very common problem, now let’s talk about it.
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We understand there’s a lot of information out there on the menopause. You can read through the NICE guidance on menopause management, as well as the NHS overview on the menopause.
