Vaginal dryness - lube or hormones
Many women experience vaginal changes due to the lack of estrogen after the menopause. Initially this can be in the form of dryness during sex. At this stage, lubricants can be used and many effective preparations are available. Some are applied just during sexual activity, others can be applied regularly to maintain the moisture. It is often a case of trial and error to find what works best.
While lubricants and moisturisers can reduce the dryness and ease the discomfort, to treat the underlying problem of the lack of estrogen and consequent changes in vaginal blood flow, secretions, thickness, elasticity and support of the vaginal skin and acidity level, consideration should be given to replacing estrogen which can either be in the form of HRT (hormones which circulate throughout the body and would be used if other generalised menopausal symptoms are also present) or vaginal estrogen.
The debate around the risks and benefits of HRT continues, but it should be understood that vaginal estrogen provides a very low dose of estrogen which is concentrated in the vagina and bladder with minimal absorption around the body. Therefore vaginal estrogen can be used by women who either do not want to take HRT, or have been advised not to take HRT.
Various types of vaginal estrogen are available and again, it may require trial and error to find which suits best. Preparations include small vaginal tablets inserted by an applicator, vaginal creams, pessaries and a 3 monthly vaginal ring. Vaginal tablets, creams and pessaries are used every night for 2 weeks, during which time there may be a little absorption and some women may notice breast tenderness. This should not cause concern. After the first 2 weeks, the maintenance dose is twice weekly, during which the absorption is minimal and any breast tenderness should settle. The vaginal ring is changed every 3 months and produces a small regular amount of vaginal estrogen. Vaginal estrogen used at the maintenance doses can be used long term, there being no known risks with many years of treatment. Indeed, we know that if vaginal estrogen is stopped, the symptoms frequently return and long-term treatment is recommended.Whatever you choose, be aware of menopausal effects on the vagina and look after your vagina in the happy, healthy years ahead!