What is Menopause?
Menopause is a transition that all women go through and the vagina is one part of the body that experiences changes. Menopause is the one day that marks 12 consecutive months without a period and while many may celebrate the end of menstruation, some women have a sense of dread due to all the unwelcome symptoms that many women suffer with.
What Happens to Vaginas in Menopause?
There are several estrogen receptors in the vagina and pelvis that rely on circulating estrogen to maintain their suppleness. As the ovaries shut down, the production of estrogen slows which can result in the tissues becoming thinner and drier. Vaginal dryness affects approximately 80% of women during peri and post menopause and does not improve with time.
Genitourinary Syndrome of Menopause
Genitourinary Syndrome of Menopause (GSM) is a term used to define a collection of symptoms associated with the vulva, vagina and lower urinary tract. The main symptoms of GSM may include dryness, irritation, painful sex, incontinence, urinary urgency and recurrent UTI’s. These can impair sexual health, fitness and overall quality of life for many women.
How Is It Diagnosed?
Health care providers will ask you about your symptoms, when your last menstrual period was, and potentially ask you to complete a questionnaire. A physical exam and vaginal pH will be checked as well. As estrogen levels decline, the vagina becomes less acidic. The pH considered normal prior to menopause is between 4.0 and 4.7. During menopause the pH level can become more elevated, closer to 5.3. Less acidity in the vagina means less defense against bacteria. Your care provider will therefore also ask you about urinary tract infections (UTI’s).
How is GSM Treated?
The good news is that the majority of symptoms that women experience under the GSM umbrella can be treated. Here are the top tips for keeping your vagina health during your menopause transition.
Avoid Scented Products and Douches – The vagina is like a self-cleaning oven and does not need cleaning. In fact, gentle soap and water on the vulva is all you need.
Check Your Ingredients – Look at your lubricants and toss petroleum-based products and opt for clean water-based options
Moisturize Your Vagina – Hyaluronic Acid helps retain moisture and can heal already dry irritated tissues. You can use gels or ovules that are inserted into the vagina at night.
Take a Probiotic – Probiotics that contain lactobacillus strains can help keep the vaginal pH optimized and can reduce the risk of infections. There are oral options and vaginal insert options.
Do Pelvic Floor Exercise – Activating the muscles in the pelvic floor stimulates blood flow which can help with lubrication.
Local Vaginal Estrogen
Speak to your doctor or naturopath about local vaginal estrogen. Local meaning it stays ‘local’ in the vagina and can help restore tissue resiliency, improve urinary symptoms and make penetrative sex possible again.
Is GSM Preventable?
It is never too late to make changes if you are already experiencing symptoms, however it is important to note that you can be proactive to maintain the health of your vagina and not have to accept that these things are ‘just part of menopause’. Pelvic floor exercise, vaginal moisturizers and avoiding scented soaps, creams and lubes can help keep your pelvic floor and vaginal happy and healthy.
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