Vaginal Dryness During Menopause. Interview with Dr. Alessia Mammaro.

Menopause causes many changes in the body. One common change for many women is vaginal dryness, which can cause pain or discomfort during intercourse, affecting the sexual life of those who experience it. We spoke with Dr. Alessia Mammaro, a specialist in Gynecology and Obstetrics at UPMC Salvator Mundi International Hospital, to learn more about the causes, symptoms, and treatments.

Dr. Mammaro, we know that menopause presents challenges for women in many ways, one of which is vaginal dryness. Can you tell us what causes it?

Vaginal dryness can occur at any age, but it is more common during menopause because the body stops producing estrogen, the hormones that regulate menstruation. Menopause is the time when menstruation ceases permanently, and pregnancy is no longer possible, usually occurring between ages 48 and 52. In addition to regulating menstruation, estrogen helps maintain healthy vaginal tissues and promotes vaginal lubrication. Without estrogen, the vaginal tissues become thin, dry, and less elastic, leading to what is known as vaginal atrophy. About 60% of women experience some degree of vaginal dryness during menopause, which can begin in the years leading up to it when estrogen levels start to decline.

Estrogen levels can also decrease permanently or temporarily due to the removal of ovaries, recent childbirth, breastfeeding, the use of anti-estrogen medications, and certain types of cancer treatments. Unlike other typical menopause symptoms, such as hot flashes, vaginal dryness does not improve over time and can worsen if left untreated. Beyond menopause, vaginal dryness can be linked to other factors such as dehydration, smoking, Sjögren's syndrome (an autoimmune disease that reduces moisture in glands throughout the body), the use of certain cold or allergy medications, and antidepressants.

What are the symptoms of vaginal dryness?

Generally, vaginal dryness causes itching or irritation around the vulva, the external area of the genital region, a feeling of tension in the vagina during sexual intercourse or pelvic exams, pain, burning, or discomfort during sex, and irritation during intercourse that may lead to bleeding or infection.

In addition to these symptoms, some people also experience burning during urination, bladder leakage, or more frequent urinary tract infections. Although these urinary issues are distinct from vaginal dryness, they occur due to low estrogen levels and are therefore very common during menopause. Physicians refer to this as genitourinary syndrome of menopause (GSM).

Not everyone experiences the same symptoms or with the same intensity; for example, the removal of both ovaries, known as surgical menopause, usually causes more severe symptoms.

Are there effective treatments for vaginal dryness during menopause?

If the symptoms are mild or occasional, relief can be found with non-hormonal treatments, such as: sufficient hydration by drinking at least eight glasses of water a day; vaginal lubricants to be used before intercourse to alleviate discomfort; vaginal moisturizers to be applied several times a week to keep vaginal tissue healthy and moist; vaginal dilators to gently stretch and dilate the vagina; and pelvic floor exercises, guided by a specialist, to help relax tense muscles and strengthen weakened ones in cases of pain during intercourse or bladder leakage.

When the symptoms are more severe and the problem persists, what can be done?

If symptoms do not improve with natural or over-the-counter treatments, it is advisable to consult a specialist, especially if vaginal dryness causes pain or bleeding during intercourse. The doctor can perform a pelvic exam to check the vaginal tissue and may recommend the use of prescription hormonal medications, either alone or in combination with other non-hormonal treatments. This includes vaginal suppositories containing DHEA to be inserted into the vagina each evening to reduce dryness; hormone replacement therapy (estrogen) in the form of pills, patches, or creams; low-dose estrogen tablets or creams to be applied vaginally as directed by the physician; a low-dose estrogen ring to be replaced every three months; or selective estrogen receptor modulators (SERMs).

Hormones bioidentical to those produced by the body are also often discussed as treatments for menopause-related vaginal dryness. These hormones are derived from plants but can carry the same risks as low-dose estrogen or hormone replacement therapy, such as blood clots, strokes, or cancer. The use of any hormonal treatment, even if plant-derived, has pros and cons, so it’s important to discuss it with your doctor.

Vaginal dryness is often a natural component of aging, but it should not cause significant pain or discomfort. If it affects sexual life or overall quality of life, it is advisable to consult a specialist who can find the most suitable solution.

If you are experiencing vaginal dryness and wish to address it, discover the gynecology packages realized by UPMC Salvator Mundi International Hospital for Pink October.