As part of our Lunch & Learn series of webinars, we were joined by Dr Imogen Shaw of Hormone Health.
This session tackled one of the most frequently asked and often misunderstood topics around menopause: vaginal health. Whether it’s dealing with dryness, discomfort, or changes that come with menopause, this will arm you with expert advice and practical solutions to keep you feeling confident and comfortable.
Henpicked: We can still be uncomfortable talking about our vaginal health, can’t we?
Dr Imogen Shaw: Yes, it’s an area of women’s health that still isn’t extensively talked about. Some women are embarrassed to come forward or maybe they don’t want to ‘bother’ their busy GP. Equally, healthcare professionals aren’t good at asking the right questions to open up the conversation with women.
Henpicked: Vaginal dryness is often associated with menopause. Does it only impact older women?
Dr Imogen Shaw: Actually it can affect women of all ages, as it’s caused by low oestrogen. Some women who take progesterone-dominant contraceptives such as the mini pill or injections and implants can notice vaginal dryness. Also, some breastfeeding women might be impacted, as their oestrogen levels can be low.
Henpicked: Why does vaginal health matter?
Dr Imogen Shaw: It contributes significantly to overall health and how women feel about themselves and their relationships. It can affect daily life and activities such as walking or riding a bike, cause discomfort with sex, make you feel miserable at work. Poor vaginal health really can intrude into all aspects of life.
Henpicked: How do you know if you have issues with vaginal health?
Dr Imogen Shaw: You might notice changes in shape to your labia or a loss of pubic hair. Internally, you have pain with intercourse or using tampons and notice itching, irritation or a sense of burning.
Henpicked: What causes this?
Dr Imogen Shaw: Loss of oestrogen and blood supply to the area, along with lack of collagen which makes up part of the labia. The whole vaginal lining and urinary tract is lined with oestrogen receptors and none of that area responds well to being low in oestrogen. Women often also experience urinary symptoms during and post menopause, such as increased frequency or urgency.
Henpicked: What are your top tips to look after our vaginal health?
Dr Imogen Shaw: Women can do a lot to help themselves. For the outside skin, I recommend a good, bland non-perfumed moisturiser. For inside the vagina I’d suggest a vaginal lubricant, which can help with intercourse. And then a vaginal moisturiser, which you can buy over the counter to help with discomfort. A good combination is using a moisturiser a few times a week with some additional lubricant for intercourse.
Lubricants can be water, oil or silicone based, but be careful with oil-based products as these can damage condoms and diaphragms. Women should use contraception for a year after their last period, or if they’re under 50 for two years after their last period.
Henpicked: Can HRT help?
Dr Imogen Shaw: If you take systemic HRT then it will help with these symptoms but for about 25% of women this isn’t enough and they need a boost of local oestrogen too. This can help to reduce and even reverse vaginal and urinary symptoms.
Oestrogen encourages the vagina to to produce glycogen, then the lactobacillus – the normal bacteria that we all have – turn this glycogen into lactic acid. When we’re younger our vaginas have a low acidic ph that can prevent bacteria which might cause infection. When oestrogen levels drop, vaginal ph rises to a neutral warm environment which is more receptive to bacteria.
Local oestrogen comes in different forms, including a cream, a pessary and a ring. The ring is like a little elastic band which sits in the vagina and releases oestrogen over three months. These need a prescription, so speak to your GP if you’d like to try one. If you’d like to use pessaries, these are known as Gina, and can be bought over the counter.
All of these are local to the vagina and bladder neck and hardly any is absorbed, so the majority of women can take them, even those who’ve had breast cancer. In these cases we would always speak with their consultant first, however.
You can use local oestrogens in conjunction with HRT. Some women choose to come off systemic HRT after they’ve been on it for a while, so it can be a good idea to start vaginal oestrogens then, to avoid symptoms suddenly appearing.
Henpicked: Do vaginal symptoms disappear after menopause?
Dr Imogen Shaw: Most menopause symptoms do abate, but vaginal dryness doesn’t so you’ll need a continuous treatment.
Watch the video here:
