Keeping your vagina and vulva healthy through menopause and beyond.
Anyone who knows me knows that I can chat at length about anything to do with the menopause. Then there are those who will occasionally refer to me as the vagina lady. Now, what’s that all about? Well, vaginal health as a topic can easily get brushed aside but it is one which I personally feel needs to be shouted about from the rooftops.
Why is that?
Vaginal and vulval symptoms affect a large proportion of women, whether that’s going through the perimenopausal years or more predominantly in the postmenopausal years. Then there are younger women who find themselves prematurely menopausal that can really suffer in this area as well.
If you’d told me 25, or even 10, years ago that one of my greatest passions would be getting all age groups to take more notice of their vulval and vaginal health I think you would have received a somewhat surprised response! But passionate I am, in addition to all other aspects of women’s health. How else are we going to help the younger generation gain more of an insight into these areas of their bodies? To become more aware, more in tune and generally more savvy, so gaining a better quality of life long term?
Which part is which?
Some women, plus quite a few girls, I speak to are still a little hazy as to which bits are their vulva. This is the external part of your genitals, including the clitoris and the labia (inner and outer sets of lips). You will find some people saying vagina when the area they are actually referring to is their vulva. When it comes to the menopause, this external area and the vagina can both be affected when oestrogen levels start to decline.
First point to make. Get to know this area of you body. It’s yours and you need to have a peek now and again. No, I’m not expecting you to be able to look up your vagina, but do have a quick peek at that external vulval area.
What should you be looking out for? Well, it should look a healthy colour, with no swellings or bumps. Look out for changes in colour, and know what is normal for you. It will literally take you five mins and can save you a lot of bother further down the line. It just requires you and a well-positioned hand mirror… not too many contortions required!
What can happen at various stages of menopause?
When oestrogen levels start to decline women can experience a variety of symptoms, from hot flushes through to joint aches. Then there are the genitourinary symptoms. I know, what a word. Basically it means anything to do with vaginal, vulval and urinary symptoms. These are classed as some of the long-term symptoms, making it even more important to get to know a bit about them.
Not everyone will suffer from these symptoms initially. They tend to be more common in the postmenopausal years and also with anyone who becomes prematurely menopausal. As with the psychological, emotional symptoms, these unfortunately can be some of the most under-reported and under-treated symptoms. This is incredibly sad, as for the majority of women they can be some of the easiest to treat.
There are medical terms like vaginal atrophy, urogenital atrophy, vaginitis which can all become a little alarming. So let’s simplify it a bit.
Whether it’s the vulva, vagina, urethra or bladder, this means thinning and shrinking of tissues in these areas. Lower levels of oestrogen can also result in reduced elasticity, irritation, dryness and a change in smell. You might also start to experience feelings of frequency and urgency.
This umbrella term refers to anything from a bacterial infection to a sexually transmitted disease to the side effects of oestrogen levels declining.
These fluctuating and declining levels of hormones can also change the ph, the acidity of vaginal secretions which can make you more prone to infections. It’s not uncommon for some women to experience infections like thrush (white discharge like cottage cheese) or to have urinary tract infections, especially in the postmenopausal years. The natural discharge can become more watery, discoloured and slightly smelly leading to irritation and a burning sensation.
Cervical secretions can decrease, which results in reduced lubrication having the knock-on effect of intercourse becoming painful and uncomfortable.
With the vulva and vaginal tissues becoming thinner and less elastic even quite gentle friction during intercourse can be painful and uncomfortable. Some women’s skin can easily break down, resulting in small breakages in the skin and in some cases bleeding.
The key word here to remember though is can. Not everyone will develop these symptoms and those that do will have such differing degrees of experience.
How do you treat these symptoms?
If you think you have an infection of any kind always seek advice from your health care professional. Try not to self medicate as it’s essential to find out if it’s a bacterial or a fungal infection.
If you’re experiencing dryness and soreness you could look into using a moisturising lubricant. There are several brands on the market. We all differ so don’t be put off if it takes a while to find one which suits your skin type.
A wee note. Please don’t start using your usual facial or body moisturisers. You wouldn’t believe the stories I’ve heard!
If you are experiencing the symptoms associated with atrophy – tissues have become thinner, less plump and you have irritation, dryness and soreness – then you could consider having a conversation with your healthcare provider about vaginal oestrogen. For the majority of women this really has been shown to have the best results with the genitourinary symptoms. The treatment is localised, going exactly where it’s needed and is a very small amount of oestrogen. The majority of women will experience little if any systemic absorption. Because the amount of oestrogen prescribed is so low there is no need to add in the progesterone component, if this is the only type of HRT you are being prescribed.
There are several ways to have the oestrogen – as a cream, pessary/vaginal tablet or gel (with applicators). There is also an oestrogen ring (Estring) which can be inserted that slowly releases oestrogen over a period of three months, after which it is replaced. This is inserted for the first time by your healthcare provider, after which you can either return to your surgery for a replacement or if you feel confident you could order a repeat prescription and replace yourself. You can safely still use your moisturising lubricant with vaginal oestrogen.
One key thing to remember is to be patient and give it time. Sometimes it can take up to three months to notice the effects.
Replacing the oestrogen can also help with some of the urinary symptoms. However, the best way to help symptoms like urinary frequency, urgency and leakage is to make sure you regularly do your pelvic floor exercises.
Pelvic floor exercises
Everyone, men and women, should do their exercises every day, preferably three times a day. The pelvic floor is like any muscle in your body – it benefits from exercise. I would highly recommend downloading an NHS app called the Squeezy App. This gives you timed exercises, reminders, explains where and what the pelvic floor is and why it’s so important for your pelvic health to give it a passing thought every day.
When thinking about your pelvic floors two words are important. Lift and squeeze. So no clenching and contorted facial expressions.
If you continue to have problems ask to be referred to a physio who specialises in women’s health. Remember it’s never too late to start, specialists treat many age groups from girls in their teens to women in their 90s.
These areas of your body will also benefit from good old lifestyle choices. Make sure you stay well hydrated throughout the day, eat a healthy nutritious diet, watch out for those caffeine and alcohol levels and reduce your stress levels. Take regular exercise and make sure you get a good night sleep.
Avoid using perfumed shower and bath products instead go for an emollient product which will help to protect and hydrate the area.
Oh and the vagina is self cleaning so no need to give it a spring clean with douches and the like… these will only exacerbate symptoms.