So much to look forward to!! Hot flashes, brain fog, joint aches, weight gain, difficulty sleeping….. Ugh! And there is more that we often don’t talk about…..vaginal dryness, waking up multiple times in the middle of the night to pee, painful sex…….Vaginal dryness can also make everyday activities like walking, exercising, or even sitting for extended periods of time uncomfortable. Beyond physical discomfort, vaginal dryness can also affect a woman’s emotional well-being. It can lead to feelings of embarrassment, self-consciousness, or a sense of loss of femininity. These emotional effects can, in turn, impact relationships and overall quality of life.
While it may not be the most comfortable topic to discuss, understanding and addressing it can significantly enhance your quality of life during midlife and beyond. Lets talk about the why’s and how’s of menopausal vaginal dryness and explore various treatment options to help you reclaim comfort and confidence. The goal is to not think about your vagina!
Understanding Menopausal Vaginal Dryness
During midlife hormone changes (and interestingly, while postpartum and breastfeeding), the body undergoes hormonal shifts, particularly a decrease in estrogen and testosterone levels. The tissue in the vagina, bladder, urethra, and vulva is incredibly sensitive to both of these hormones. This decline can lead to thinning, drying, and inflammation of the vaginal walls and vulva and changing of the vaginal PH, resulting in discomfort, itching, infection, vaginal dryness, and pain during intercourse. Women also experience more frequent urinary tract infections and need to wake up multiple times at night to use the bathroom. While it’s a natural part of the aging process, it doesn’t mean you have to endure it silently or let “nature take its course”.
Here is the scoop on the different treatment options. I will start with my favorite and most effective. Just like we don’t flinch about using a facial moisturizer forever, our vaginal health depends on applying topical hormones regularly. Unfortunately, If you don’t continue to use these, they won’t work.
- A vaginal DHEA suppository called Intrarosa/prasterone is FDA-approved and made from DHEA (dehydroepiandrosterone). It is excellent for vaginal and bladder health. DHEA is a precursor hormone that can be converted into both estrogen and testosterone in the body, helping improve vaginal moisture, elasticity, and bladder health. Using intrarosa will keep your vagina healthy for years to come. This is safe for ALL women, even those with breast cancer.
- Vaginal estrogen therapy: This can be administered via vaginal creams, rings, or tablets. Estrogen helps restore the vaginal tissues’ thickness and elasticity, effectively alleviating dryness and discomfort. Everyone is a candidate for vaginal estrogen. Multiple studies have shown the safety of vaginal estrogen, even in those with a personal history of breast cancer. Studies have shown that not only does vaginal estrogen alleviate discomfort from symptoms such as dryness, it also will prevent urinary tract infections!!
Non-hormonal options include:
- Carboxytherapy with CO2 Lift. Topical application with this innovative treatment involves the gentle infusion of carbon dioxide gas into the vaginal tissues, stimulating blood flow, collagen production, and tissue regeneration. Not only does it improve vaginal lubrication and elasticity, but it also enhances sensation and overall comfort.
- CO2 Lasers such as the Mona Lisa. Three treatment sessions six weeks apart and then once yearly for maintenance with a CO2 fractionated laser transforms vaginal tissue at the cellular level, increasing collagen, elastin, and hyaluronic acid production. This will help increase moisture and repair the tissue without needing messy creams or using hormones.
- Moisturizers: Vaginal moisturizers are designed to hydrate the vaginal tissues and provide long-lasting relief. They come in various forms such as creams, gels, and suppositories. Regular use, typically several times a week, can help maintain moisture.
- Lubricants: Unlike moisturizers, lubricants provide immediate relief during intercourse. They reduce friction and discomfort, enhancing pleasure and intimacy. Water-based, silicone-based, and oil-based lubricants are available, each with its unique advantages. Experimenting with different types can help you find what works best for you.
Dr. Karen Toubi understands the unique challenges and symptoms faced by women with Genitourinary Syndrome of Menopause (GSM). Her holistic approach involves a deep dive into each patient’s specific needs to provide personalized care. If you are experiencing vaginal dryness or GSM, don’t suffer in silence. Schedule a consultation with Dr. Karen Toubi at Rodeo Drive Women’s Health Center to discuss your symptoms and explore your treatment options. Dr. Toubi and her team are dedicated to helping women feel comfortable and confident in their bodies at every stage of life.
