The advent of menopause usually thins the vaginal and urethral lining. These changes increase your chances of contracting vaginal infections. The decrease in estrogen produced by the ovaries can also lead to vaginal dryness.
This can result in vaginal and vulva itching, as well as pain during intercourse. We recommend monitoring for signs and symptoms of vaginal infections, such as an itchy feeling in your vagina, sometimes coupled with a burning sensation.
Fortunately, there are things you can do to reduce the symptoms of vaginal dryness in menopause.
The first thing you should do is to discontinue using harsh soap on the inner lips of the vagina. Instead, just use plain water to clean these parts of your genitals. Use white toilet paper that has no scent in it and wash your underwear in soaps that contain no perfumes or dyes.
Don’t use any anti-cling sheets in your laundry and don’t use fabric softeners when you do laundry, as these can be irritating. Don’t use perfumed douches or lotions on the inner lips of the vulva.
There are many lubricants you can purchase over the counter in order to maintain vaginal lubrication. Some of these include the following:
- KY™ jelly
- Just Like Me™
- Summer’s Eve Lubricant™
- Slippery Stuff™
- Pure Pleasure™
- ID Millennium™
Avoid using petroleum-based lubricants such as petroleum jelly as they do not actually lubricate the vagina and can actually increase the irritation. They can also cause breakage of latex condoms.
There are prescription estrogen-based vaginal products you can get from your doctor. These include the following:
- Estrace vaginal cream
- Vagifem vaginal tablet
- Neo-Estrone cream
- Premarin Cream
- Estring vaginal ring
Any of these vaginal moisturizers can effectively reduce the vaginal dryness and can make intercourse more pleasurable. Try the over the counter preparations first and, if these don’t work, go to the prescription products.
The vaginal estrogen creams and tablets are safer than taking oral estrogen because they deliver the estrogen to the vaginal tissues and are not absorbed appreciably by the rest of the body. They can thicken the vaginal mucosa and can increase lubrication.
You can also use “warming” vaginal lubricants. These are available over the counter and are designed to increase sexual responsiveness by containing a small amount of capsaicin in the lubricant.
These types of lubricants can be very helpful in increasing sexual responsiveness but some women say that the lubricants will increase irritation of the vaginal tissues.
Vaginal moisturizers can be used. They are applied on a regular basis to moisturize the vaginal tissue and have effectiveness that lasts about 3-4 days and they work by mimicking the vagina’s normal vaginal secretions.
They are usually applied using an applicator and are available over the counter or online. You can use both vaginal moisturizers and vaginal lubricants together to reduce vaginal dryness.
Some women prefer using vaginal estrogen treatments. These involve the use of the products listed above. Estrogen vaginal treatments are known to increase the blood flow to the vagina so that the vagina has increased elasticity and thickness.
They offer lasting relief of vaginal dryness and can be used on a long-term basis. These are available by prescription and take a while to take effect.
Oral Estrogen Therapy
If you need more relief of menopausal symptoms than just vaginal dryness, you may want to use oral estrogen therapy. These will help all of the symptoms of menopause, including hot flashes, night sweats, mood swing, urinary tract symptoms, and vaginal dryness.
For severe vaginal atrophy, however, the prescription vaginal creams, rings, or tablets are what are primarily recommended.
Local vaginal estrogen therapy is very effective, with about 93 percent of women indicating significant improvement in their symptoms.
Up to 75% of women indicate that the pain on intercourse resolves using this type of therapy. Always use the lowest effective dose and talk to your doctor if you have a history of breast cancer as estrogen therapy may be contraindicated in women who have had breast cancer.
How To Use Estrogen Vaginal Preparations
If you are using estrogen-containing vaginal cream, you apply small amounts in the range of 0.5 to 1.0 grams in an applicator 2-3 times per week. They should not be used prior to intercourse as the estrogen in the cream can be absorbed in the man’s skin with adverse effects.
If you are using the Estring vaginal ring, you insert it into the vagina, where it is worn for three months before replacement. It stays up near the cervix and does not have to be removed prior to having sex. Estring is used exclusively for vaginal dryness and is different from Femring, a type of vaginal estrogen-containing ring that contains higher doses of estrogen for the management of the other symptoms of menopause.
If you are using the vaginal tablet known as Vagifem, you simply use your finger or an applicator to insert the tablet about twice weekly. Vaginal tablets are generally less messy than the estrogen-containing creams.
The type of vaginal estrogen-containing product you use depends on your and your doctor’s preferences. Individual responses can occur so you may need to try another product if one product does not seem to be effective. You can use lubricants and moisturizers on top of the estrogen-containing vaginal products, as they do not mix badly with one another.