Menopause is a natural biological process that marks the end of a female reproductive year and usually occurs in her late 40s or early 50s. One of the most common and often challenging symptoms associated with menopause is vaginal dryness. This is a condition that can have a significant impact on women’s quality of life and intimate relationships. Also, many women experience mental health issues.
InfininaGynecologist Dr. Susanna Answorth shares her valuable insights, practical advice and evidence-based solutions to empower women to go through the menopause (and the menopause cycle) and embrace this transition with confidence and comfort.
Vaginal dryness – Key indicators of menopause and menopause
Research suggests that at least 50% of women experiencing the transition of menopause experience vaginal symptoms, suggesting that dryness is the first symptom associated with hormone loss and tends to lead to vaginal atrophic changes.
I think the number is much higher as it is a symptom that many women have endured without asking for help. In my clinical practice, I always ask specifically about these symptoms so that women can speak from their own experiences. I think at least 80% of the women I see have experienced some degree of vaginal symptoms.
Dryness, itching, burning, increased discharge, urinary symptoms, and painful gender are all potential symptoms. Here we refer to this collection of symptoms as menopause urogenital syndrome.
Postmenopausal women, particularly older women, often struggle with recurrent urinary tract infections due to atrophic vaginal changes associated with hormone loss. These can often be misdiagnosed as urological problems.
What helps in vaginal dryness?
Loss of hormones associated with menopause is a natural process that cannot be prevented. However, if these symptoms affect your quality of life, this does not mean that you have to endure these symptoms.
I generally recommend avoiding perfume-type products, choosing a well-balanced, intimate health product, and avoiding internal vaginal irrigation, as some things can make things worse. You can also avoid synthetic materials and consider the materials in which your underwear is made. It can also be helpful to avoid doing too much pressure on the vulva. For example, riding or cycling for a very long time (and ensuring good support/padding if you are).
Vaginal Moisturizers and Lubricants You can make sure that the products used are specially designed for vaginal use. Anything that contains hyaluronic acid is especially useful. Natural oils such as coconut oil are also useful for some women.
However, the most effective treatment available is hormones. Most are made up of localized estrogen forms. These are delivered to the vagina as small tablets, pessaries, creams, gels or rings. Tablet forms can now be purchased at the counter.
They are considered safe for use by most women as they are very effective in treating vaginal dryness and atrophy symptoms and do not cause an increase in estrogen levels in the bloodstream. It can also be used in many women after breast cancer. However, this should always be discussed with your doctor first (the only situation that may be concerning is also true of women who use drugs called aromatase inhibitors as part of breast cancer treatment). There is another hormone pessary containing dehydroepiandrosterone (DHEA). This is also effective and could be a potential option for women who are using aromatase inhibitors.
Painful sex
To help with discomfort and pain during sex, we recommend using a regular vaginal moisturizer using appropriate lubricants during the sex. However, ultimately, we also recommend using vaginal hormone treatments. It may take a little time for your symptoms to improve, so it is also essential to talk to your partner and avoid penetrating sex until things feel comfortable.
Pain during sex can lead to long-term problems like vaginitis, so it’s best to tackle it before any other issues arise and enjoy sex in other ways while things improve.
The effect of menopause on mental health
Hormonal changes definitely affect mental health. We are often seen in women who notice mood changes throughout the normal menstrual cycle and sometimes change through extreme outcomes (such as PMDD). It is often caused by levels of hormone fluctuations/changes that can trigger. This is why women often struggle with changes in their mood during the perimenopause due to a large number of hormonal fluctuations.
The most common symptom I see is low mood and anxiety. This is because it can often happen suddenly and was not suffering from mental health issues before. Cognitive changes have also been commonly reported, with a classic explanation of “brain fog.” All of these are important, especially in the workplace.
There are conflicting opinions regarding the role of hormone therapy in the management of these symptoms. Data show mood benefits, and HRT is recommended over antidepressants when treating changes in mood that are associated with menopause. The impact on anxiety is less clear, but in my practice there is improvement in this as well.
The impact on cognitive function is more complicated. It has been suggested that improvements are made when HRT is used in young women, particularly women experiencing early menopause. However, when used in older women, the evidence is less clear. Some data suggest cognitive decline when HRT is introduced after the menopause has already occurred. More research is needed in this field.
Mental health treatment advice
Like all the elements of menopause care, I am trying to take a personalized, holistic approach. It is important to look at social issues and lifestyles. Many factors affect mental health and it is important to address them. Otherwise, other treatment options are unlikely to be useful.
I always look at diet and exercise and encourage non-medical options. Nevertheless, psychological treatment options such as cognitive behavioral therapy are also extremely helpful.
HRT also plays an important role in my approach to treatment. We are not necessarily in a hurry to use it only for people experiencing anxiety or depression. Still, it is rare that it is the only symptom of menopause. Combinations of other symptoms (such as hot flashes, joint pain, vaginal problems, and changes in duration) are all suggested towards changes in menopause hormones, and these symptoms are generally ameliorated with appropriate HRT treatment.
Antidepressants should not be offered as first-line treatment for menopause-related mood and anxiety, but adding more antidepressants below may be useful for some women.
How to live a healthy and fulfilling life
Menopause is definitely not the “end.” For some women, it can feel like a “beginning” – freedom from the constraints of hormone roller coasters linked to the menstrual cycle. It is important to emphasize that many women can experience a very positive menopause transition. But women need to support through it. This could be support from family, friends, workplace colleagues, employers, or healthcare professionals who provide appropriate treatment when symptoms affect quality of life.
All women’s experiences are different and many options are useful. When I hear a woman being told to just “ride it,” it makes me sad – yes, it’s a natural process and a part of life, but that doesn’t mean that women need to suffer silence. If appropriate education, support and treatment is available and women have access to these, I think all women will thrive through this transition and come out stronger on the other side.
In conclusion, it is essential to assume menopause and understand how to deal with the discomfort it brings to many women, ultimately promoting women’s health and well-being at this stage.
