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DEAR MAYO CLINIC: I began menopause about two years ago at age 52. I am noticing that I am beginning to experience vaginal dryness. Is this normal? Is there anything that can be done about it? I have tried using over-the-counter lubricants, and they don't help much.
ANSWER: Vaginal dryness is common in women who are approaching menopause and those who have gone through menopause. Other related symptoms include vaginal and vulvar irritation; burning or itching; discomfort or pain with sexual activity; and urinary symptoms, such as more frequent or urgent urination, urge leak, and urinary tract infections. Together, these symptoms are referred to as "genitourinary syndrome of menopause," or GSM. These symptoms occur in roughly half of menopausal women and are even more common in women with breast cancer.
In contrast to hot flashes, which typically improve over time, symptoms of genitourinary syndrome of menopause generally do not get better with time and may worsen. Over-the-counter products can help. But when they do not, prescription medications are often a useful alternative.
Before menopause, a thin layer of moisture coats the vaginal walls. When a woman is sexually aroused, more blood flows to the pelvic organs. That produces more lubricating vaginal fluid. But hormonal changes can affect the amount and consistency of the moisture. For middle-age women, those changes are frequently triggered by menopause.
As a woman ages, her body makes less of the hormone estrogen. In the time just before and during menopause, estrogen decline becomes more rapid. As a result of the loss of estrogen, blood flow to the vagina decreases, the walls become thinner and less elastic, and moisture decreases.
Several types of over-the-counter nonprescription products are available to relieve vaginal dryness. Water-, oil- or silicone-based lubricants can be effective, and they are intended to be used for sexual activity. Moisturizers that mimic your body's natural lubrication are used regularly — every one to three days — to help maintain vulvar and vaginal moisture. For the greatest effect, they need to be used consistently. You may need to try a few varieties of these products to find the one that works best for you.
You also may be able to decrease vaginal dryness by avoiding the use of products on sensitive vulvar and vaginal tissues that could cause irritation, such as antibacterial or perfumed soaps, bubble baths, bath oils and hand lotion. Also avoid perfumed or scented toilet paper and laundry detergent. Do not use douches, or flavored or warming lubricants.
Make sure your partner knows what's happening, too. Talk about what feels good during sex and what doesn't. When you are intimate with your partner, give yourself plenty of time to become adequately aroused. That can help with lubrication. Having painless intercourse regularly also may reduce vaginal dryness. It is important to note that intercourse should not be painful.
If those steps are not enough to overcome dryness or discomfort with sexual activity, make an appointment to see your health care provider. In addition to confirming that your symptoms are related to menopause and not some other cause, he or she may suggest a prescription that contains a low dose of hormones delivered locally to vulvar and vaginal tissues. Topical forms of dehydroepiandrosterone (vaginal insert) and estrogen (vaginal cream, ring, tablet and insert) effectively treat vaginal dryness and pain with sexual activity related to loss of estrogen. These products are used as long as needed to manage symptoms, and they can be used long term without concern for serious side effects. An oral medication — ospemifene — is a selective estrogen receptor modulator, or SERM, that also is approved to treat vaginal dryness and painful sex related to menopause. Your health care provider can help you decide which prescription treatment is right for you.
Although vaginal dryness is a common problem for women your age, it is not a condition that you have to learn to live with. Safe and effective treatments are available that can help women reduce vulvar and vaginal dryness, and remain sexually active long past menopause. — Dr. Stephanie Faubion, director of the Center for Women's Health, Mayo Clinic, Jacksonville, Florida