Vaginal dryness can be a big issue during menopause. It makes you feel uncomfortable. But don’t worry, treatments can help. This guide will tell you how to make them work for you. From estrogen tablets to gels like Vagifem, there are many choices. If you can’t use estrogen, there are other options like oxytocin and DHEA gel. Testosterone and new drugs like Ospemifene and Bazedoxifene also give more options. Let’s explore how these treatments can make you feel better!
With such a wide range of treatments available it can be confusing to decide which one is right for you.
It is best to make this decision with the help of your doctor. Vaginal dryness is one symptom that persists well beyond just the menopausal period and treatment options can change as you age, whether or not other problems like bladder symptoms crop up.
There is a simple way to help you decide.
Here is how to implement the decision process and the treatment options so that they work for you.
1. Use a symptom tracker
Here you can see an example of a symptom tracker built in a spreadsheet. There are several available as apps too that you can use. Just highlight the most important symptoms for you and start tracking.
Use a symptom tracker – available online or in apps
The benefit of tracking is that you can identify those that are most bothersome for you and help you to discuss them with your doctor. Take your chart with you when you go to see your doctor so that you have something objective to share.
2. See your doctor / gynaecologist for a diagnosis
It is very tempting to start treating yourself after reading an article like this on the internet. Or after talking to a friend or confidante. I would encourage you to take all that you have learnt and see your doctor or gynaecologist anyway.
You can discuss the options for treatment with the doctor. After all, some of the most effective treatments need a prescription and those that do not, probably have little effect anyway.
Besides, your doctor is more able to determine if you are eligible for hormone treatment based on your medical history and any contraindications to it. If you have had treatment for cancer other treatments may be more appropriate. If you do end up needing medication, it is far better to be under the care of a physician who knows what to expect in case something untoward happens.
3. Are you comfortable touching your genitals or putting medication inside your vagina?
This so important that it bears repeating.
For any vaginal treatment to work you first need to be comfortable touching your genitals and putting medication inside the vagina either with your fingers or with an applicator. If for any reason this doesn’t seem suitable for you tell your doctor first.
This is because local vaginal treatments in the form of moisturizers or hormone creams, gels, tablets etc. are often the first line of treatment for menopausal vaginal dryness.
If you are uncomfortable with this route this treatment option is not suitable for you right now. Things may change in future and you can always consider this option later.
4. Determine if other menopause symptoms are bothersome
If you have several other symptoms of the menopause that are bothersome and affecting your quality of life your doctor can determine the scale of severity using a Menopause Rating Scale. There are several versions of this and any one is ok to determine how severely your symptoms are affecting you. The symptom tracker you keep is also good for this purpose.
The reason for this is that vaginal dryness may be part of this symptom complex and may be treated with a variety of specific treatments such as oral estrogen, estrogen patches, rings or gels, androgens, other medications like Bazedoxefine, Tibolone, Ospemifene, oral probiotics or oral phytoestrogens.
Whichever medication you decide to start with, it is best to discuss the advantages and disadvantages, risks and benefits of them with your doctor. This includes the several home remedies and ‘natural’ products we talked about.
5. Vaginal dryness after cancer treatment
If you are suffering with vaginal dryness after receiving cancer treatment you fall into a special category and treatments need to be supervised carefully. You may be eligible for some local hormone treatments under the supervision of your oncologist.
Newer non-hormonal energy-based treatments like laser can give better relief of symptoms than home remedies alone. The treatment effect can be variable and be aware that several sittings may be required before you feel significant relief from vaginal dryness and discomfort.
Very often you can continue to use the different home remedies to give temporary relief of the itching and burning sensation that often accompanies vaginal dryness.
6. Using local non-hormonal treatments
You can first try non-hormonal local treatments if you are comfortable with touching your genitals and inserting your fingers or applicators into the vagina.
Vaginal dryness creams can include moisturizers, lubricants, vaginal probiotics and vaginal phytoestrogens. We have discussed these in detail above.
The best lubricant for vaginal dryness is a water-based lubricant because it is less likely to cause allergies or alter the vaginal microbiome. A water-based lubricant can also be used with sex toys without worrying about damaging them.
You can try using local non-hormonal treatments first
There is limited data available for how well vaginal probiotics and phytoestrogens work. It is best to track your symptoms in the tracker to determine if you are getting the relief you need.
Remember, treatment with vaginal estrogen cream, tablet or ring is very safe and highly effective. Eventually, nothing works quite as well as estrogen. Your doctor can help you determine if it is safe for you to use estrogen vaginally to treat your symptoms of vaginal dryness and discomfort.
7. Lifestyle interventions
As a part of managing your symptoms put into place the lifestyle interventions we discussed earlier. These are supportive of any medical treatment you undertake. Stopping smoking and resuming exercise make a difference to your overall health as well as in improving symptoms of menopause. If you are obese or overweight, consider looking for support to help you release your excess weight and get fit. You can read more about weight gain in menopause here.
Diabetes mellitus can make vaginal symptoms much worse and be associated with severe candida infections. Consult your doctor regarding a diabetes check up and put into place the system you need to get it under control.
8. Sex and relationships
Various methods like Cognitive behavioral therapy (CBT) and Psychosexual therapy are used to intervene when relationships are strained due to poor sexual interactions. Painful sex can be a turn off and affect interpersonal communication. You can read more about sex and menopause here.
Treatment options for vaginal dryness and painful intercourse
It really helps to include your partner in the treatment process and help him to understand the problems associated with menopause symptoms and lack of estrogen. He is much more able to participate in the treatment process. Intimacy can be restored and treatment can help you to enjoy sex without discomfort.
If you think you are experiencing difficulty in your sexual relationship as a result of vaginal dryness, pain and discomfort in spite of treatment do talk to your doctor about a referral for therapy. Just being able to talk openly about the problem can do wonders for your sex life.
Conclusion
Vaginal dryness and atrophy (Vulvovaginal atrophy -VVA) is a chronic medical condition that is one of the most bothersome symptoms of the menopause.
It has a significant negative effect on quality of life. Vaginal dryness and atrophy is associated with itching, burning, pain with intercourse and urinary problems.
In spite of how common it is (over 35% of menopausal women and over 65% of women over the age of 55) it is poorly managed.
Considering that this problem does not get better with time and can damage vaginal health and structure it needs to be addressed early so problems can be prevented.
It is important to address lifestyle issues and relationship stress alongside seeking medical treatment.
A variety of medical treatments are now available – systemic and local, hormonal and non-hormonal. They can significantly reduce the effect of vaginal dryness and atrophy on quality of life especially in menopausal women.
Women who have undergone treatment for cancer with chemo or radiotherapy suffer much worse symptoms of vaginal dryness and treatment options are limited if their cancer was hormone dependent.
Newer drugs and local energy treatments can significantly improve quality of life for these women and they should consult their doctor early and talk about these issues.
Estrogen therapy remains the most effective treatment for moderate to severe symptoms and ultra low dose medication is also now available.
Don’t hesitate to ask your doctor about this if your home remedies and natural preparations do not give you the relief you need to improve your quality of life. Now that you have the information you need and can use a symptom tracker, you can approach your doctor with confidence that vaginal dryness and its associated symptoms can be treated effectively.
I hope you have found this article useful and will put into use the tips I have shared to make vaginal dryness treatment work for you.
Do write to me at masterthemenopause@gmail.com about what you liked in this article and whether it helped you address some of your concerns.
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