What Causes Vaginal Dryness in Menopause?

Vaginal dryness is probably one of the most annoying symptoms you can experience during menopause. It can also be very subtle. It starts with the usage of artificial lubricants in perimenopause. To impossibly painful sex in postmenopause. Over half of women over the age of 50 suffer from vaginal dryness. This increases up to 80% of postmenopausal women.

Why do you get vaginal dryness in menopause? 

Vaginal dryness is caused by atrophy (or shrinking) of the vaginal epithelial cells. Under the microscope, you can see that the healthy, plump squamous cells become shriveled like raisins. The medical term is atrophic vaginitis and it’s caused by the declining estrogen levels in menopause. Estrogen helps to keep all your tissues lush and juicy, especially vaginal tissues. With less intracellular fluid, there’s a lot less moisture. Your vagina becomes very dry and cannot lubricate itself enough. 

Lack of enough lubrication during sexual arousal can lead to very painful intercourse. Lack of enough estrogen can also lead to urinary tract infections. This is because your urethra, the tube from which urine exits from your body. It is very estrogen-dependent. During menopause, your urethra can also become atrophic. Which renders it unable to keep normal vaginal bacteria from entering the bladder. Especially during intercourse or even after bathing. Which leads to bladder infections. The treatment is not chronic use of antibiotics, but to prevent the infections in the first place. 

Can HRT help?

The very best way to treat vaginal dryness is to use hormones. Not systemic, but topical vaginal estrogen is the best treatment. Systemic hormone replacement therapy would have to be quite excessive in order to heal the vagina. You can maintain vaginal health with systemic hormone replacement therapy. But you can’t rescue an incredibly dry, atrophic vagina without using topical estrogen therapy. 

The two types of estrogens that seem to work the best are estriol and estradiol. Estradiol can be used as a pharmaceutical preparation, or it can be compounded. Estriol must be compounded.

I find estriol works the best to get the vagina back to its healthy juiciness. Just a couple of milligrams nightly for at least six to eight weeks can rejuvenate atrophic vaginitis. Then, you can lower the dose to whatever is needed for maintenance. Which may just be once a week or so. Then, systemic bioidentical hormone replacement therapy can help maintain vaginal health. 

What alternative therapies help menopausal vaginal dryness?

The best way to keep your vagina healthy is to support your hypothalamus. My patients who take Genesis Gold® find that they need much less HRT and their vagina stays properly lubricated longer through the change. That’s because the herbal blend in Genesis Gold® helps maintain healthy hormone receptors. 

The best natural lubricant is coconut oil. It helps maintain proper vaginal PH to prevent bacterial or fungal overgrowth. While coconut oil will help protect thin atrophic vaginal tissues, it will not restore them.

Even if you have estrogen-related cancers, using topical estriol vaginally can be a safe alternative to systemic estrogens. It can also help get your vagina and urethra back in shape. 

If you have any questions regarding vaginal dryness, please join us in our Hormone Support Group. You can access it when you sign up for my free Hormone Reboot Training below. I hope to see you there!