Kathie Bishop - 02/11/22
Vaginal Dryness in Menopause
Hi,I’m Kathie, medical herbalist, founder of Into the Wylde and expert in vaginal ecology. I’m here today on behalf of Forage Botanicals to talk about something that is still sadly counted as a taboo in our society: vaginal dryness. Vaginal dryness is one of the most common symptoms of vaginal atrophy. When patient of mine reports experiencing this they describe that it feels like a burning sensation or irritation. It can make penetrative intercourse painful, which can result in tissue damage. Overall, it often disrupts daily life and comfort. From working with patients I know it can range from mild discomfort to feeling like shards of glass in the vagina. However, because it can feel similar to other chronic vulvo-vaginal conditions1, it may result in those suffering with it to delay getting the help they need1, or trying to self treat with things not suitable to help with vaginal dryness. Vaginal dryness is most commonly experienced in peri-menopause and menopause but it can also be experienced during pregnancy or breast feeding, those taking certain medications, such as those used for hay fever, fibroid and endometriosis medication, or those who do not get their periods for medical reasons1. For those who experience this due to the menopause, it is likely to be a daily occurrence.
Why do people get vaginal dryness in menopause?
Atrophy is technically defined as the wasting (thinning) of a body tissue or organ as a result of the degeneration of cells. This happens to the vaginal cells as a natural process of the menopause due to the decline in circulating levels of oestradiol 2. Oestradiol is the most potent form of oestrogen, produced during the biologically fertile years by the ovaries 2. In the vagina, oestradiol plumps the vaginal tissue and encourages a lactobacilli (beneficial bacterial) rich environment, which keeps the vagina healthy, through the production of a glycogen-rich lubrication2. But in post-menopause, the levels of this form of oestrogen are low. There are a couple of other forms of endogenous (produced by the body) oestrogen that are still available, however, the physiological effect they exert is much milder2. The vagina and vulva are innervated by two branches of the vagus nerve and feelings of discomfort can be particularly acute in the vagina due to the rich nerve supply to this area. The vagina can become, in effect, hyper-sensitised, and so any repetitious pain feels escalated, exponentially increasing the discomfort.
Vaginal dryness is a common issue for all natal-women. Up to 57% of post-menopausal women report having symptoms1. It must be remembered that in reality this number may be much higher, however cultural or religious beliefs that may play a factor in under reporting1. Also, being embarrassed or not realising something can be done can be a reason that people don’t seek help. So if you find something that works, make sure you tell your friends all about it!
What other implications can it have?
A modified vaginal environment caused by low levels of oestrogen increases risk of infections like bacterial vaginosis (BV), as there are less lactobacilli in the space to keep the BV causing pathogens at bay. Vaginal dryness may also make intercourse or other daily activities, such as sports or wearing of leggings or tight jeans, uncomfortable.
What can we do about it?
Protecting the vaginal mucosa, encouraging healthy blood flow to the area and using topical preparations that have been shown to alleviate the main symptoms of vaginal atrophy are key ways we can look to address vaginal dryness in menopause.
Fennel (Foeniculm vulgare). In an Iranian study, Fennel seed oil was able to help alleviate some of the main symptoms of vaginal atrophy (itching, burning, dryness and dyspareunia) in post menopausal women, as well as improving the pH and cell health of the vagina in these circumstances2. This is huge and very helpful for women experiencing this, who would rather look into natural methods over HRT to improve the situation.
Seabuckthorn (Hippophae rhamnoides) oil - rich in fatty acids, in particular Omega 7, I often recommend this to my clients to improve vaginal mucous membrane integrity. Omega 7 is a key component of mucosal cells and may stimulate skin generation, helping wounds to heal more quickly and I would recommend taking a teaspoon (or 3gm if capsules) a day to help improve vaginal mucosa in those suffering with vaginal atrophy2.
Marshmallow root (Althea officinalis radix.) - a wonderfully mucilaginous herb, Marshmallow root is wonderful for inflammation of the mucous membranes. The mucilage protects and soothes mucous membranes and seems to have an effect on all mucous membranes in the body, even those it doesn’t come into contact with. It is surmised that this is via some sort of reflex action across mucosal membrane sites2.
Damiana (Turnera diffusa) - considered an aphrodisiac, central nervous system stimulant and pelvic bowl activator, the beautiful herb damiana is one of my favourite herbs for connection to the pelvic bowl, sexual energy and creative awakening. Our knowledge of it comes mostly from traditional South American use, and can be helpful in creating or recreating a positive relationship with our pelvic bowl and sexual anatomy. While research has found that some of the constituents isolated from damiana may act in a similar way to steroidal sex hormones2, damiana may exert its effects by increasing blood flow to the area, which may encourage our natural function of lubrication.
Top Lifestyle tips
Vaginal lubricants - Using a daily vaginal moisturiser like Wylde One for comfort can be a very useful strategy and one that is easy to use on the go. Formulated with vaginal physiology in mind makes it the perfect product for this purpose. Another thing worth bearing in mind is comfort during penetration. On the whole, patients report a mix of oil and water lubricants provides maximum comfort and longevity, with the need for reapplication minimal. One thing to be aware of is that oil-based lubricants are not compatible with condoms or similar devices.
“I really love your product, Wylde One, and it has made SUCH a difference to my sex life. I am post menopausal and until I found your product I was beginning to think that that part of my life was over, and feeling pretty depressed about it as well. But not now! Thank you for making it!!” - Val
Breathing Exercises - It has been shown that exercise and nose breathing practices may increase nitric oxide, which in turn increases blood flow to the vagina. As the basic component of vaginal discharge/lubrication is transudate, or liquid from our blood, which has been pushed out of our capillaries and through the cells in vaginal tissues by the force of blood pressure, it may well be worth exploring these practices further to increase production of natural lubrication3.
It’s worth knowing that for some who are suffering with severe symptoms may choose to investigate oestrogen creams, which are typically thought to have lower risks associated for developing oestrogen-dependant breast cancer, due to the localised nature of their use. Always seek professional medical advice around this and thoroughly weigh up the risk-to-benefit ratio before deciding this is the treatment for you.
What can we do about it?
Anytime your symptoms are causing you pain or disrupting your life in any way, seek out help from a medical herbalist or a doctor who understands menopausal symptoms. The best thing to do is to always seek help, rather than staying silent - it is important that your quality of life is not reduced, even though this is a consequence of an entirely natural process. You don’t need to suffer. Nor suffer in silence.
Although an on-going, unfortunately common, and potentially very uncomfortable situation, please remember that there is no need to feel alone. Talking about it and sharing stories helps you and others. And remember, there are products out there such as Wylde One, that you don’t need a prescription for, and others, such as fennel cream and pessaries that you need to see a herbalist for, that can help you. Sure, it involves an addition to your daily self care routine, but the benefits are there and its definitely worth investing in your quality of life.
1. Bleibel B, Nguyen H. Vaginal Atrophy. [Updated 2022 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559297/
2. Bishop, K. It’s Your Power Portal: Take Control of Your Vaginal Health with Herbal and Holistic Care. 1st ed. Aeon Books; 2022
3. Editor(s): David Rakel, Contributor: White, W, Integrative Medicine (Fourth Edition), Elsevier; 2018