Menopause & perimenopause

Vaginal dryness — you have options

by Marcy Holmes, NP, Certified Menopause Clinician

Many patients come to me first when vaginal dryness causes difficulty with their sex lives. But oftentimes this isn’t their only problem; the soreness, burning, and itching that accompany vaginal dryness can make it uncomfortable to sit, stand, exercise, urinate or even work. Vaginal dryness can affect our everyday lives, whether or not we are sexually active.

Perimenopausal and menopausal women with vaginal dryness often tell us they feel like their bodies — and their lives — are drying up. Even my younger patients worry about early menopause and permanent changes in the vagina. First, I’ll say that neither your body nor your life is drying up! The vagina is very resilient — and so are you.

Vaginal dryness is a common symptom and there are many possible causes for it, from diet and stress to — one of the most frequent issues — hormonal imbalance. Like almost everything in our lives, feeling better depends on finding the underlying cause and your unique solution. With some willingness to explore and the right support, vaginal dryness can be easily remedied — the natural way.

A healthy vagina

Moisture is normal for a healthy female vagina, and so is a reasonable amount of vaginal discharge. Though vaginal discharge does change naturally with your hormonal cycles and aging, normal vaginal fluid is typically a clear to whitish substance with a pasty or slippery consistency and no strong odor. It will include a stringy, egg-white-like discharge from the cervix, or what is called fertile mucus, at around the time of ovulation. With sexual arousal, you will typically experience slippery, clear secretions from small glands on either side of the vulva called the skenes glands. (To learn more about changes in vaginal secretions, read our article on predicting ovulation.)

Your body relies on the hormones estrogen and progesterone to produce adequate lubricating secretions for your vagina. During perimenopause and menopause, when hormones are shifting, it’s very common for some women to experience vaginal dryness as fewer secretions are produced. However, women of all ages can experience vaginal dryness. And there are a variety of reasons for it, some of them less complicated than others.

Common causes of simple vaginal dryness

If you are experiencing vaginal dryness, look into the following common causes first. You may find that changing one or two of these factors can give you relief from your symptoms right away.

Personal hygiene products. Feminine sprays and harsh soaps (especially antibacterial and deodorant soaps) can rob the delicate vaginal and vulvar tissues of moisture. Even Dove and Ivory, though cleverly marketed to appear gentle, can dry your genital tissue because they are not pH-balanced. Many feminine douching products can also cause more harm than good, a well-known fact in medicine that still has not reached all women. Swimming pool and hot tub chemicals can also be terribly drying to all of our skin cells, including those in the vulva and vagina. You may also want to switch to a laundry detergent containing no perfumes or other irritants that could remain as residue on your underwear.

Diet. Estrogen is essential for lubricating the vagina. Since estrogen is ultimately produced from cholesterol, our bodies’ ability to efficiently produce and metabolize estrogen relies heavily on the fat we consume in our diets. But while there is a correlation between fat in our diets and estrogen levels, we need to remember to consume fats that help us create health and hormonal balance rather than those that promote disease. Hydration is also key for all the mucous membranes of the body to remain moist. While we like to think of drinks containing caffeine and alcohol as part of our diet, caffeine and alcohol have drug-like actions, including a diuretic (dehydrating) effect, that can be much more pronounced in some women. Women in perimenopause and menopause may have more difficulty clearing the body of these substances, and overconsumption of either — particularly alcohol — can exacerbate vaginal dryness.

Medications. Certain drugs, including allergy and cold medications and some antidepressants, tend to dry out mucous membranes, including vaginal tissues. The birth control pill is also a common cause of vaginal dryness because the hormones it contains are not natural to the human body.

If you have ruled out the above factors, you may be experiencing some degree of hormonal imbalance, a very common root cause of vaginal dryness in women over 40.

Vaginal dryness and hormonal imbalance

Disorders associated with vaginal dryness While lifestyle measures, hormonal imbalance, and stress can contribute to vaginal dryness, there are also a number of medical disorders that may cause or present with vaginal dryness. For example, the autoimmune disease known as Sjögren’s syndrome can cause vaginal dryness in addition to dry eyes and dry mouth, due to the body’s own attack on the glands responsible for secretions. Women with a range of other underlying vaginal disorders often present to our clinic with vaginal dryness. We review atrophic vaginal changes, more severe atrophic vaginitis, lichen sclerosis, and vulvodynia in relation to vaginal dryness in our subpage on conditions associated with vaginal dryness. Some of these issues are rare and can be difficult to recognize, so we strongly recommend seeing a gynecological provider or nurse practitioner specializing in menopause as opposed to a general practitioner if you are concerned about these issues, or if the natural support measures we recommend do not provide enough relief.

Your hormones can lose their delicate balance for a number of reasons, the most common of which is the hormonal shifting that occurs during perimenopause and menopause. (This imbalance can be even more severe in women who have had a hysterectomy.) Depending on your genetics, diet and lifestyle, your body will naturally begin to shift its hormone production as it prepares to end ovulation cycles.

Because progesterone levels tend to diminish first as women enter perimenopause, some women experience a relative increase in estrogen levels, and they may need to balance that shift with progesterone supplementation (see our article on estrogen dominance for more information). Others, particularly women who are near or past menopause, may experience a drop in both estrogen and progesterone levels. Given that one of estrogen’s many responsibilities is to keep the vagina lubricated, it’s very common for a drop in estrogen to lead to vaginal dryness.

While commonly thought of as a problem for women in perimenopause and menopause, hormonal imbalance can also occur in women who have premature ovarian failure, polycystic ovarian syndrome (PCOS), anorexia, or pituitary and hypothalamus issues; and in women who have recently experienced childbirth, are breastfeeding, have imbalanced diets, have gone through cancer therapy, or smoke cigarettes.

Stress, emotions, and vaginal dryness

One very important cause of vaginal dryness that often goes unrecognized is stress. This is particularly common in younger women prior to perimenopause. After I hit 30, I was working 10-hour days, getting very little sleep, stressed out, drinking too much coffee with not enough water intake, and not eating as well as I could. When I started experiencing vaginal dryness, I worried that I was in early menopause. But in looking back, I realized that I was pushing my body to the limit without enough support, and making little to no time for restorative behavior or sexual thinking. Then getting pregnant made it clear: this was not early menopause lurking for me; I just needed to take better care of myself physically and emotionally.

Many of us tend to ignore the physical manifestations of stress, yet it can have a powerful impact on our systems. By taxing the adrenals, chronic stress drives down androgens (such as testosterone), which can interfere with the normal female sexual response cycle. This can ultimately affect the stages of arousal and reduce natural lubrication. Many causes of stress arise in our overextended lives, which is why simply taking some time for yourself or making a permanent change in your schedule can help tremendously.

Stress can also stem from deeper emotional work we have yet to do. Scientists are discovering more and more about the relationship between emotions (especially negative ones) and sex hormones in the body and brain. Interestingly, we now know that the brain contains hormone receptors. Though we are still learning about this, research is linking our emotional history with our sexual hormones, and could help explain why the latter may be tapped out.

There are many programs available for emotional healing. The Hoffman Institute, where the Quadrinity Process is taught, has been a great resource for many of our patients — but their courses require a significant financial and time commitment. The Emotional Freedom Technique (EFT), while not as extensive, can be practiced at home or with a trained EFT practitioner. Both offer you the tools you need to gently unearth emotions about your past and deal with them in a healthy way so that they no longer negatively impact your wellbeing.

Vaginal dryness and sex

I can’t tell you how many women come to the clinic thinking it’s over. They’re dried up, they fear, and they’ll never have sex again. I always tell them this story:

I had an 80-year-old patient who hadn’t had sex since her husband died 20 years earlier. She told me that she had a new boyfriend and, as she put it, they were getting “hot and heavy.” The only problem was that she was getting recurrent urinary tract infections. She asked me if it was wrong at her age to have so much passion. Of course not, I told her, and explained that because she’d gone so long without sex, she had some atrophic changes in her vagina and urethra, which is why she was getting so many urinary tract infections.

In her case, topical estriol vaginal cream helped boost the local estrogen and plump up the vaginal tissue and urethra, while also providing more moisture. A lubricant also helped reduce friction when they had sex and to prevent any irritation. A year later, she had married her boyfriend and they were off traveling in Europe.

What I find so inspiring about this woman is her passion. No matter how old we are, we always have the ability to rekindle our sexual desire. She found her libido again, despite low hormone levels consistent with her age.

Most of the women I talk to feel the opposite is true — their bodies are fine but their passion is gone — or they’re somewhere in the middle. How we deal with sex and arousal is a big factor when it comes to vaginal dryness, menopausal or not. It’s also important to understand that sometimes vaginal dryness during sex can stem from simply not being sufficiently “turned on.” A woman needs about 20 minutes of thinking about sex before her body fully responds physically. When women are stressed, the last thing they think about is time for feeling sexy, yet we all need this time to get the brain primed and ready. Vaginal dryness and low libido in general can be remedied and need not get in the way of a fulfilling sex life. To learn more about the physical aspects of libido, read our article on low sex drive in women — causes and solutions.

If sex continues to be a painful experience for you despite these efforts, it may be helpful for you to explore your sexual history. Research tells us that up to one in three women may have been sexually abused, and though it’s difficult to bring these memories to the surface, past sexual abuse can manifest itself physically in your body, especially when, as is usually the case, there are unresolved feelings and emotions. We’ll be dealing with this sensitive topic in a later article, but you can refer to the programs mentioned above for support in emotional healing.

Using your self-knowledge and instincts as a guide, you can find the underlying causes of your vaginal dryness. And once you understand the root causes, you can start investigating solutions.

Natural solutions for vaginal dryness — the Women to Women approach

Unfortunately, many women are living with vaginal dryness because conventional medicine isn’t offering options that work for them. I talk to women all the time who tell me their doctors say their only options are to use synthetic hormones, or to try Premarin vaginal cream or old-fashioned K-Y Jelly. These options go from one extreme to another, but what many women don’t know is that there are plenty of options in-between, and most of them you can get from your conventional practitioner.

Keep in mind that it may take some experimentation before you find what works. At Women to Women, we always advocate for beginning at the root cause of a problem. And this begins with taking the time to listen to our bodies. With an understanding of what is out of balance, you can guide your recovery through your own reading and, if necessary, find a practitioner willing to provide options that work for you.

The following suggestions for natural support can be highly effective for vaginal dryness. We always recommend a natural approach first. If your vaginal dryness doesn’t resolve right away, don’t give up; even if these options don’t cure your vaginal dryness, they can augment the effects of any prescriptions you may decide to use and possibly allow you to use a lower dose for a shorter duration.

Stay hydrated. This may seem obvious, but if you’re chronically dehydrated, your body is going to have a hard time staying lubricated. Remember that all caffeinated and alcoholic beverages can dehydrate you, too. So, drink plenty of water whenever possible.

Choose gentle hygeine products. Don’t use douches or perfumed feminine hygeine sprays, and avoid the use of drying soaps and bubble baths. Try pH-balanced soaps that do not include antibiotics or chemical deodorants.

Eat a balanced diet. Eating a well-balanced diet, including an appropriate amount of healthy fats, will support your overall health and make sure your body is making as much estrogen as it can. Also be sure to eliminate simple sugars and food sensitivities.

Increase soy isoflavones in your diet. Many women respond very well to daily intake of whole soy foods, which are high in isoflavones and lignans known to be helpful for vaginal dryness. One particularly good option is Revival Soy. (See our article on using soy for menopausal symptoms.) While soy and flaxseed contain some of the highest levels of phytonutrients helpful for vaginal dryness, there are many other foods that contain phytoestrogens which, by mimicking the body’s natural estrogens, serve as a buffer when levels fluctuate. Adding these foods to your diet could give you the extra little hormone boost you need. Foods high in phytoestrogens include soy, other legumes, nuts, apples, celery, cherries, flaxseed, and many more. As always, eating a diet rich and varied in plant foods helps balance your hormones, and it’s one of the easiest ways to treat vaginal dryness!

Take a medical-grade nutritional supplement. Giving your body the highest level of nutritional support available is always a good idea, no matter what symptoms you’re experiencing. Your body simply cannot function normally or heal itself without the necessary ingredients. In the case of vaginal dryness, vitamin A, beta carotene, and B vitamins are particularly helpful. We know also that omega-3 essential fatty acids support healthy cell membranes and hormonal balance. The Personal Program offers an excellent option with our Essential Nutrients.

Perform regular self-exams. It may seem like an odd thing to add to your to-do list, but we encourage you to make time to look at your vagina regularly with a mirror. If you keep track of changes, you may be able to link them to dietary habits, changes in your cycles, emotional situations, and so forth.

Try a quality lubricant. Instead of sticking with the old K-Y Jelly, which contains methylparaben, consider a more natural lubricant like Sylk or the new paraben- and glycerin-free Astroglide. Some women have success with a dab of natural oil, like sweet almond or grapeseed, after bathing. A personal lubricant can greatly help some women during sex, and can be a fun part of foreplay.

Look into vitamin E suppositories. Many women with vaginal dryness have had success using vitamin E suppositories. Vitamin E applied locally can help restore thin vaginal tissue. Vitamin E suppositories are available to members of our Personal Program by special request from our Nurse–Educators. You may also find them in certain health food stores or a compounding pharmacy without a prescription.

Consider phytotherapy and other hormone therapies. Ancient cultures used plants like black cohosh, red clover and kudzu to treat vaginal dryness. These phytoestrogens have proven helpful for reducing vaginal dryness in many studies.

Since low estrogen is at the core of most vaginal dryness in perimenopause and menopause, localized estrogen therapy is the most effective treatment for stubborn cases. We like to suggest bioidentical estrogen creams or suppositories that are applied directly to the vagina, rather than ingested like conventional forms of higher-dose synthetic HRT. Since the bioidentical estrogen vaginal creams work directly upon the genital tissue at a low dose, only trace amounts of the estrogen enter the circulation and the associated risk is generally considered very low.

Choosing the right bioidentical vaginal estrogen product is key. Estriol is the weakest of the three estrogens, but I find it works very well for plumping up thinning tissues. Pharmaceutical companies have yet to develop a brand name estriol product, but you can obtain a prescription for a custom-compounded vaginal estrogen cream or suppository from a healthcare provider who prescribes bioidentical hormones. We also recommend several brand name prescription estradiol products, like Vagifem vaginal inserts and Estrace vaginal cream.

Read our subpage on natural estrogen options for treatment of vaginal dryness for more information. Even some women on low-dose systemic HRT, like the patches, need this extra vaginal support.

Confront negative emotions and stress. If other measures haven’t worked for you, it may be helpful to explore your past. Writing in a journal or talking to a trusted friend can help you uncover answers you may have overlooked. Your emotional well-being is vital to a healthy body. If you have any negativity regarding sex, relationships, or your partner, talk to someone about your feelings. Bottling them up may allow them to easily resurface.

Don’t wait to take steps to help your vaginal dryness!

Whether it’s menopause that is causing a shift in estrogen production, an unbalanced diet, stress or an emotional past, our bodies are all unique. And in the end, taking the time to get to the bottom of your vaginal dryness allows much more room for personal growth, comfort and happiness.

Know that vaginal dryness is a natural symptom of hormonal imbalance, and we have had great success in helping women restore lubrication naturally. Treatment may come from a variety of sources, but it is your own body that decides which remedy or combination of remedies is the right one. If one option doesn’t have the desired effect, work with your practitioner to find another. (See our articles on talking with your doctor about menopause or bioidentical HRT for additional guidance.) There are many roads to the solution.

Related to this article:

References & further reading on vaginal dryness

 

 

Original Publication Date: 07/02/2007
Last Modified: 02/16/2010
Principal Author: Marcy Holmes, Certified Menopause Clinician