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Vaginal dryness

Vaginal dryness is a common symptom experienced by women when they go through the menopause transition and possibly for many years after. However, vaginal dryness can happen at any age for several reasons.

What are the possible causes of vaginal dryness?

Vaginal dryness is the result of decreased levels of estrogen. Estrogen is the female hormone that keeps the lining of the vagina lubricated, thick, and elastic.  

Lack of vaginal moisture may not be a big deal to some, but it can have a large impact on a woman’s sex life by causing pain and discomfort during intercourse. Fortunately, there are several different treatments available to relieve the symptoms of vaginal dryness.

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INFORMATION

Women who smoke go through menopause earlier than others who do not, and so vaginal dryness may occur at an earlier age in this group.

Causes of vaginal dryness

Vaginal dryness is most often due to a drop in estrogen levels. Estrogen levels begin to decrease as menopause approaches. The ovaries produce estrogen that controls the development of female body characteristics, such as breasts and body shape. Estrogen also plays a significant role in the menstrual cycle and pregnancy. 

Usually, estrogen keeps the tissues lining the vagina thick, moisturized, and healthy. As levels decline, women notice that the lining of their vaginas become thinner, drier, less elastic, and light pink to blue in color. These changes are known as vaginal atrophy.

Estrogen levels can also drop for reasons other than menopause, such as:

  • childbirth and breast-feeding 
  • treatments for cancer, including chemotherapy and radiation 
  • “surgical menopause,” when the ovaries are removed surgically for any reason 
  • anti-estrogen drugs used for breast cancer or endometriosis, such as Lupron or Zoladex
Other causes of vaginal dryness can include:
 
  •  Sjögren’s syndrome. This is a complex autoimmune disorder that involves inflammation of the salivary and tear glands. The tissues lining the vagina can also become inflamed, which leads to vaginal dryness. 

  • Antihistamines. These drugs, such as diphenhydramine, are used for cold and allergy symptoms and work to dry up secretions. Side effects can include vaginal dryness and trouble urinating. 

  • Antidepressants. Some antidepressants come with sexual side effects, such as vaginal dryness, decreased libido, and difficulty achieving orgasm.

Relation to menopause

Vaginal dryness is related to menopause due to the drop in estrogen levels that comes with the latter. Research suggests that about 20 percent of women in perimenopause and postmenopause seek treatment for vaginal dryness. 

However, the actual number of those experiencing the symptoms is thought to be closer to 40–50 percent overall. 

Vaginal atrophy and vaginal dryness can cause pain and discomfort during sex and increase the chance of vaginal infections. Decreased estrogen levels also thin the lining of the urinary tract, which can result in more frequent urination and urinary tract infections. These symptoms have come to be known as genitourinary syndrome of menopause, or GSM. With GSM, women may also notice bleeding after sex or vaginal burning and itching. 

These symptoms can certainly affect how a woman enjoys sex and how she feels about herself. Of course, every woman who goes through menopause will experience symptoms differently, and these will have varying degrees of severity. No two women will have the same experience.

Accompanying symptoms

Other symptoms commonly associated with vaginal atrophy and vaginal dryness include vaginal itching, burning, and irritation. These vaginal changes make it easier for infections to occur.  As mentioned, the decreased levels of estrogen during perimenopause reduce the amount of natural vaginal secretions.  

Falling levels of estrogen can also result in a tightening of the vaginal opening and a narrowing of the vagina itself. Pain during intercourse is associated with these changes and is known as dyspareunia.  

Women in the perimenopausal period may also experience some of the following symptoms:

  1. hot flashes 
  2. night sweats 
  3. insomnia 
  4. mood changes 
  5. fatigue 
  6. acne 
  7. urinary symptoms 
  8. memory problems

Treatment & Remedies

There are many different treatment options available for vaginal dryness. A doctor can prescribe some, and some can be obtained over the counter.

 

Topical estrogen cream 

A common treatment of vaginal dryness caused by low estrogen levels is topical estrogen therapy. This means medications that are applied directly to the vaginal area to relieve symptoms.  

This method involves much less absorption of estrogen when compared to estrogen taken as a pill. As such, these medications are felt to be a fairly low risk.  Examples of topical estrogen therapies include:

  • Vaginal ring (Estring). This flexible ring is inserted into the vagina where it continually releases low amounts of estrogen into the tissues. The ring is replaced every 3 weeks. 

  • Vaginal cream (Estrace, Premarin). An applicator is often used to apply the cream into the vagina. Research has shown that estrogen cream is an effective and well-tolerated treatment for vaginal atrophy and dryness when compared with a placebo. 

  • Vaginal tablet (Vagifem). This treatment also involves an applicator to place a tablet into the vagina.

 

Research that looks at the long-term effects of topical estrogen is currently lacking. The methods given here are considered to be safe, however, especially when compared with traditional hormone replacement therapy.  

Women with a history of breast cancer or who may be pregnant or breast-feeding should talk to their doctor about the safety of topical estrogen therapy. Nonhormonal treatment options are available.