The importance of maintaining vaginal health during menopause

A brief Guide to your vaginal well-being 

The hormone estrogen keeps your vagina healthy by acting as a natural lubricant. It also stimulates the cells in the lining of your vagina to encourage the presence of ‘good’ bacteria that protects against infection.
As estrogen levels in your body decline during the perimenopause and menopause, the vagina, vulva, and urinary tract can suffer from a lack of estrogen. The tissue lining your vagina thins (known as vaginal atrophy or atrophic vaginitis) and becomes drier. Your bladder and the tube running from it (urethra) also thin and become weaker which can cause you to need the toilet more often and feel very desperate to go, without much notice.

Understanding Menopause and Vaginal Health

As estrogen helps cells to fight off harmful bacteria, a lack of this hormone makes you prone to urinary tract infections, such as cystitis. This can cause issues such as:

– Vaginal dryness: Reduced estrogen can lead to a thinner, less lubricated vaginal lining. 

– Itching and irritation: Dryness often causes discomfort or itching. 

– Pain during intercourse: Thinner, less elastic vaginal tissue can make sex uncomfortable. 

– Increased risk of infections: A decrease in vaginal acidity can create an environment more prone to infections, such as bacterial vaginosis or urinary tract infections. 

Why Vaginal Health Matters

Maintaining vaginal health during menopause is crucial for several reasons: 

1. Comfort and quality of life: Addressing dryness and irritation can improve day-to-day comfort and intimate relationships. 

2. Prevention of infections: Healthy vaginal tissue is less susceptible to infections. 

3. Urinary health: Vaginal and urinary tract health are closely linked. Neglecting vaginal health can increase the risk of bladder issues. 

How to Maintain Vaginal Health

1. Adopt a Healthy Lifestyle

– Stay hydrated: Adequate hydration supports overall and vaginal health. 

– Eat a balanced diet: Foods rich in phytoestrogens (like soy and flaxseeds) and omega-3 fatty acids can help counteract estrogen loss. 

– Exercise regularly: Physical activity improves blood flow, including to the pelvic area, supporting vaginal health. 

2. Use Vaginal Moisturizers and Lubricants

– Moisturizers: Regularly apply vaginal moisturizers to maintain hydration in the vaginal tissue. 

– Lubricants: Water-based or silicone-based lubricants can ease discomfort during intercourse. Avoid products with fragrances or irritants.

3. Consider Hormonal or Non-Hormonal Treatments

– Localised estrogen therapy: Vaginal creams, rings, or tablets containing low-dose estrogen can relieve dryness and other symptoms and help to restore tissue health.

– Non-hormonal options: Products like hyaluronic acid-based gels or vaginal laser therapy may also be effective. 

Effective treatments for vaginal dryness – Local estrogen:

Because these symptoms are due to a lack of estrogen, a very effective solution is to put estrogen directly on the affected area. This is known as ‘local’ or ‘topical’ estrogen and it is not the same as the estrogen you take as part of your HRT; vaginal estrogen treatments can be taken safely for a long time, with no associated risks. Local estrogen is available via a prescription your healthcare professional can advise on which type would be best for you, there are two types of estrogen used – estradiol and estriol – and three main ways to absorb the estrogen directly from
the vagina and surrounding area.

Pessary: The most common choice of vaginal estrogen is to use a pessary, such as Vagifem® (containing estradiol). This is a small tablet you insert into the vagina, using an applicator. It is administered daily for the first two weeks, and then twice weekly after that. Women usually insert the pessary at nighttime so they can stay in place in the vagina for several hours. If twiceweekly doesn’t improve symptoms, it can be used more frequently under advice from your healthcare professional. Imvaggis® pessaries are a more gentle, lower dose alternative and contain estriol. They look like small, waxy bullets and do not require an applicator for insertion, so are more environmentally friendly. They can, however, sometimes result in a discharge when the product dissolves and leaves your vagina. Women use one pessary every night for 3 weeks, then twice a week thereafter. There is another type of pessary that is different to other estrogen preparations Intrarosa® contains DHEA, a hormone that our body naturally produces. Once positioned in the vagina, the DHEA is converted to both estrogen and testosterone. It is can be used with or without an applicator and the usual dose is one pessary every night.

Cream or Gel: Estrogen creams, such as Ovestin® (containing estriol), are inserted inside the vagina on a daily basis for the first fortnight, and then twice weekly after that. An applicator can be used to insert the cream in the vagina or it can be applied with the fingertips on and around the vulva area as well which can be useful if you are experiencing itching or soreness of the external genitalia too.
Blissel® gel is a newer product that also contains estriol. This is a lower dose option (but not quite as low as Imvaggis) and it has an applicator to insert the gel inside the vagina. It is used every night for three weeks, then twice a week after that.

Ring: An alternative way to use vaginal estrogen is with an estrogen ring, such as Estring®. This is a soft, flexible, silicon ring you insert inside your vagina. The ring’s centre releases a slow and steady dose of estradiol over 90 days and it therefore needs to be replaced every three months. A health professional can insert the ring, if a woman does not feel confident or able to do so. The dose released is slightly stronger than the Vagifem pessary. Women can leave the ring in position to have sex, or can remove and reinsert it themselves, if preferred.

Vaginal Moisturisers and Lubricants: As well as vaginal estrogen treatments, there are moisturisers and lubricants that do not contain estrogen but act to keep the tissues well hydrated and feeling less sore. Moisturisers are for help throughout the day and are longer lasting, so you might only need to use a moisturiser every two or three days.
Lubricants are for using just before having sex. Recommended brands of vaginal moisturisers are YESTM VM, Sylk Intimate, and Regelle. Sylk can also be used as a lubricant and YES have lubricants known as YES OB or YES WB. If you are using condoms for contraception, and use a lubricant when having sex, make sure it is a waterbased lubricant as this type will not dissolve the latex in the condom.

4. Practice Gentle Hygiene

– Wash using warm water and a mild unscented soap to avoid disrupting the vaginal microbiome. 

– Always opt for breathable, cotton underwear and change out of damp clothing promptly. 

How to Monitor Vaginal Health 

Self-Check Routine

– Notice changes: Pay attention to any changes in discharge, odour, or discomfort. 

– Watch for symptoms: Red flags include persistent itching, burning, unusual discharge, or bleeding outside of expected patterns. 

– Track infections: Recurrent urinary tract infections may indicate underlying vaginal issues. 

Regular Medical Check-ups

– Discuss any symptoms or concerns openly, including sexual health with your GP or health care provider 

When to Seek Medical Advice

– Persistent dryness or pain that does not improve with over-the-counter products. 

– Signs of infection, such as unusual discharge or odour. 

– Bleeding after menopause, which can be a sign of a more serious condition. 

Empower yourself with knowledge and care. Vaginal health is an essential part of a woman’s overall health, especially during menopause. By staying informed, adopting a proactive approach, and seeking medical guidance when needed, you can navigate this life stage with confidence and comfort. Remember, changes during menopause are natural, but you don’t have to face them alone—support and solutions are readily available.