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Vaginal Health

The Menopause Transition

  • 40 – 60% women will find themselves dealing with menopause symptoms including vaginal dryness
  • Peri-menopause - means "around menopause“. Also called the menopausal transition.
  • Women start peri-menopause at different ages. You may notice signs sometime in your 40s. Can be as early as their mid-30s.
  • The level of estrogen — the main female hormone — in your body rises and falls unevenly during peri-menopause
  • Menopause - defined as the time when there has been no menstrual periods for 12 consecutive months and no other biological or physiological cause can be identified.
  • The end of fertility (a woman may still, however, be able to become pregnant unless 12 consecutive months have passed without a period).

 

Effects of Menopause on Vaginal Health

Bodies change as we age. For women this can mean that as oestrogen levels drop, vaginal dryness and atrophy can occur.  The walls of the vagina can thin and become very delicate, leading to tearing and splitting and this is known as atrophy. Other causes of vaginal dryness can be immune disorders such as Sjogren’s Syndrome, reaction to medications and treatment such as chemotherapy.

Unfortunately for many women vaginal problems don’t just stop at dryness. Ongoing pain and discomfort from episiotomy scars (NatFem customers in their 60s who are still suffering with this. Hormonal changes during menopause also impact the biota of the vaginal environment and changes can result in an increase in conditions such as candida and lichen sclerosus. These can be painful and debilitating problems that can all contribute to dryness, itching, pain and discomfort, which an also have a detrimental impact on wellbeing and relationships.

In pre-menopause, breastfeeding, stress, and underlying conditions such as diabetes, inflammatory bowel disease, chronic heart failure, hypothalamic amenorrhea, and hyperprolactinemia can all cause vulvovaginal atrophy. Medication such as antidepressants and anti-estrogen medication and treatments such as radiotherapy and chemotherapy at any point in a woman’s life, can result in vaginal dryness. VVA is exacerbated by perimenopause, menopause, and advancing age[1].

In New Zealand alone, around 256,000 women are suffering from one or a number of these symptoms right now. That is over 6 percent of the total population of New Zealand

VVA can present and manifest with a number of symptoms: vaginal dryness, soreness, chaffing, dyspareunia, vaginal discharge, and post-coital bleeding. As well as being distressing in themselves, these symptoms have a knock-on effect on daily life. They can affect sexual relationships, reduce or prevent sexual enjoyment, and impact on daily activities such as sport and physical activities[2]. The nature of the symptoms can cause embarrassment and prevent women from seeking advice and treatment.

When your vagina and vulval area is splitting, itching and burning, normal activities such as physical activity and intimacy can become extremely painful.

Many of our customers have told us how this has impacted on their personal relationships - and that they feel societal attitudes mean they can't talk about it. There is a sense of the topic of vaginal health as being 'taboo'.

 

Good Bacteria, Bad Bacteria and the Hidden Horror of Glycerin

Estrogen causes vaginal lactobacilli to proliferate. This reduces the pH and prevents colonization from pathogenic bacteria such as Enterobacter. As estrogen levels decline in postmenopause, lactobacilli numbers also fall and thus vaginal pH rises. This provides more favorable conditions for enterobacteria and other pathogens from the gastrointestinal tract to colonize and increase the likelihood of urinary tract infection[1].

Most water-based lubricants that have glycerin in them. Glycerin is a metabolic by-product of sugar and may cause candidal growth[2] and infection and, counterintuitively, may cause mucosal drying. Vaginal application of all types of glycol increased susceptibility to herpes simplex virus 2 in a mouse model[3]. Vaginal health is dependent upon healthy colonization with a lactobacillus-rich microbiome. Studies have shown that glycols/glycerin kill these bacteria in vitro, suggesting a higher likelihood of infection as a result. Lubricant use has been associated with an increased incidence of bacterial vaginosis.

Read our blog about glycerin here.

 

Atrophy (vaginal) - as oestrogen levels drop, vaginal dryness and atrophy can occur.  The walls of the vagina can thin and become very delicate, leading to tearing and splitting and this is known as atrophy. We made NatFem balm to help with this problem and we also have lots of tips for natural ways to keep things juicy in our blog and podcast.

Candida - hormonal changes during menopause reduce the acidity of the vagina which can result in an increase in conditions such as candida. things to avoid to help peevent candida: pantyhose, synthetic underwear, douches, soap and bubblebaths

Dryness (vaginal) - as oestrogen levels drop, vaginal dryness and atrophy can occur.  The walls of the vagina can thin and become very delicate, leading to tearing and splitting. NatFem Botanic Super-Soothing Balm can help this.

Fissures - The posterior fourchette is a thin fork-shaped fold of skin designed to stretch at the bottom of the entrance to the vagina. However, it sometimes fails to stretch properly, and instead splits. This is a cause of recurrent vulval pain. Pain from fissuring is often described as being 'like a paper-cut' or 'knife-like'. Recurrent fissuring has been previously called vulval or vulvar granuloma fissuratum. The splitting occurs when the vulva stretches, particularly during sexual intercourse.

Itching (vaginal) – vaginal itching and burning (referred to as “pruritus”) can occur due to irritating alkaline vaginal secretions on tender vaginal tissues, thrush or bacterial infections. Lichen sclerosus can also be a contributing factor. Tight, synthetic underwear doesn’t really help. NatFem balm can help soothe and calm irritated bits and our Day and Night tinctures can also help alleviate this uncomfortable problem.

Lichen Sclerosus - onset is commonly postmenopausal, a relative lack of oestrogen may be significant. Lichen sclerosus primarily involves the non-hair bearing, inner areas of the vulva. It can be localised to one small area or extensively involve perineum, labia minora (inner lips) and clitoral hood. It can spread onto the surrounding skin of the labia majora and inguinal fold and, in 50% of women, to the anal and perianal skin. Lichen sclerosus never involves vaginal mucosa. Lichen sclerosus can be extremely itchy and sore. Sometimes bruises, blood blisters and ulcers appear after scratching, or from minimal friction (eg, tight clothing, sitting down). Urine can sting and irritate. Sexual intercourse can be very uncomfortable. NatFem has helped a number of women with this problem.

Painful sex – dryness and atrophy due to menopause can make sex painful. Dyspareunia is defined as persistent or recurrent genital pain that occurs just before, during or after intercourse. NatFem Balm can really help reduce this pain. It is lovely to use during intimacy (as long as not using condoms) and can help soothe any vaginal and vulval pain after sex.

Urinary Tract Infections (UTI’s) – changes to the pH level of the vagina and the thinning of vaginal walls can create conditions for UTI’s. Glycerin which is an ingredient in water-based lubricants can also feed ‘bad bacteria’ and become a catalyst for UTIs.

Vaginitis – this is a term for vaginal inflammation and infections. Changes in pH level during menopause can make these more common.

 

Sources include:

https://dermnetnz.org/

[1] Raz R. Urinary tract infection in postmenopausal women. Korean J Urol 2011;52:801–8

[2] Brotman RM, Ravel J, Cone RA, Zenilman JM. Rapid fluctuation of the vaginal microbiota measured by Gram stain analysis. Sex

Transm Infect 2010;86:297–302

[3] Moench TR, Mumper RJ, Hoen TE, Sun M, Cone RA. Microbicide excipients can greatly increase susceptibility to genital herpes

transmission in the mouse. BMC Infect Dis 2010;10:331

[1] N. Potter & N. Panay (2021) Vaginal lubricants and moisturizers: a review into

use, efficacy, and safety, Climacteric, 24:1, 19-24, DOI: 10.1080/13697137.2020.1820478

[2] The North American Menopause Society. Management of symptomatic vulvovaginal atrophy: 2013 position statement of TheNorth American Menopause Society. Menopause 2013;20:888–902

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