The Dos and Don’ts of Caring for Your Vaginal Health During Menopause

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During our reproductive years, we may not give much thought to keeping our vaginas healthy. In spite of the fact that many companies advertise lotions, creams and wipes, a vagina that has regular estrogen exposure needs none of these products in order to stay healthy. The vagina has its own microbiome,  its own ecosystem. In the absence of infection, lactobacilli, multiple strains of beneficial bacteria found in the body and predominant in the vagina, generally maintain the vaginal environment at a healthy, acidic pH level. Various species of lactobacilli grow in a healthy vagina, and produce lactic acid, which helps keep bad bacteria at bay and contributes to the beneficial and balanced vaginal microbiome.

During menopause, however, there is a decrease in the amount of estrogen being produced by the ovaries, and then estrogen production stops altogether. It is this lack of estrogen that can lead to a constellation of symptoms, including vulvar and vaginal dryness, burning, irritation, painful intercourse, urgency and burning with urination, among others.

Suddenly, during perimenopause and menopause, vaginal health becomes a topic that requires more thought, consultation, and action. During menopause and beyond, the vagina will become drier, the tissue thinner, and it will eventually have less blood flow and less moisture. This may continue to get worse if we do nothing. The good news is there are steps we can take to care for our vaginal health during and after menopause. Here are some tips to keep in mind.

Tips for Vaginal Health During Menopause

1. Acknowledge Vaginal Changes

First, and most importantly, is the awareness that your vagina and vulva may experience noticeable changes. Once we are near, or in menopause, the recognition that our estrogen levels are declining (which can commonly present as symptoms such as hot flashes, irregular periods, insomnia, and low energy) should make us mindful of the fact that those declining estrogen levels may also have an effect on the tissues of the vagina. We need not wait until a problem (pain, urinary tract infection, difficulty with sexual encounters) presents itself to address this.

It would be lovely if all health care practitioners (or even all gynecologists) initiated a proactive conversation with us about vaginal health; but the truth is, many do not. We can either choose to wait these symptoms out, or we can bring it up when we see our healthcare practitioner.

2. Consider Regular Sexual Activity During and After Menopause

At the top of the list of things that keep the vagina healthy is to have regular sexual activity, in addition to using a lubricant or moisturizer consistently, if needed. This can including some type of penetrative sex, if that is something you desire.

Maintaining regular sexual activity is one of the best ways to help ensure that you will be able to continue to be sexually active during menopause and beyond; the concept ‘if you don’t use it, you’ll lose it’ is somewhat true in this context. If this does not, or cannot happen with a partner, solo sexual activity counts too--comfortable, regular self-sexual play, manually or with the help of a sex toy, to keep the blood flowing to the vaginal area, is highly recommended.

3. Keep a Balanced Vaginal Microbiome

The goal of any treatment to keep the vagina healthy during menopause is to restore and maintain the normal vaginal microbiome. As mentioned earlier, if lactobacilli are diminished in  the vaginal environment, lactic acid will not be produced. The job of lactic acid is to keep the pH of the vagina low. Anything that helps safely keep the vaginal pH low can be a contributor to maintaining good menopausal vaginal health.

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One effective option for maintaining a healthy vaginal environment is to replace the estrogen that is missing. Vaginal estrogen comes in a variety of vehicles: creams, small vaginal pills, suppositories, and a silicone vaginal ring. Any one of these, used regularly, will help restore the estrogen stimulation to the vaginal cells; this in turn will encourage the growth of lactobacilli, and lower the pH. Vaginal estrogen stays local; it is not the same as using or taking systemic estrogen replacement in an oral pill or a patch and will not treat hot flashes or other lack-of-estrogen menopausal symptoms. Alternatively, a prasterone vaginal insert can be used nightly, which metabolizes into a small amount of estrogen and testosterone when placed in the vagina. This provides a similar effect to estrogen applied vaginally: adding moisture and assisting in the balance of vaginal pH.

Hormone treatment is not for everyone, which is why it’s important to talk through any treatment options involving hormones with your healthcare provider first. Some women cannot or would rather not use vaginal hormones for a variety of reasons. This does not mean that other options are not available.

4. Understand the Non-hormonal Options: Vaginal Moisturizers, and Lubricants

Vaginal moisturizers, like hyaluronic acid and polycarbophil-based vaginal moisturizers, used 2-3 times a week, can provide long-term vaginal moisture and correction (or maintenance) of the vaginal pH, without the use of any hormones. They must be used regularly and consistently to have the desired effect.

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Lubricants are recommended for timing with sexual activity. They only work at the time of application and are not intended to be a long-term solution to treat symptoms. They can be water, silicone or oil-based and experimenting with different brands and textures may be helpful.

Many perimenopausal or menopausal women turn to so-called ‘feminine hygiene products’ in order to increase lubrication or to try to make their vaginas “healthier”. However, many of these products do more harm than good.

Studies looking at the connection between feminine hygiene products (including fragranced intimate washes, wipes, douches and lotions) and vaginal infections have drawn some strong conclusions on which products to avoid. One study demonstrated that the use of gel sanitizers and intimate wipes in the vagina were associated with an 8 to 20 time increase in bacterial vaginitis and yeast infections. The use of intimate cleansing wipes increased the chance of getting a urinary tract infection two-fold.²

Some over-the-counter, multi-ingredient vaginal moisturizers may also suppress the growth of healthy lactobacilli, which can potentially cause the vaginal environment to harbor bacteria and result in vaginal infections.

5. Maintain an Open Line of Communication with your Healthcare Provider

There are many ways to properly care for your vaginal health during and after menopause. Some treatments are available over-the-counter, and some require a prescription. But please, refrain from self-diagnosing or self-treating.

During perimenopause and beyond, it’s important to keep an open and consistent line of communication with your gynecologist or healthcare provider to help manage any symptoms or changes in vaginal health that you may be experiencing. If there is unusual vaginal discharge, burning, itchiness or discomfort, please first visit your healthcare practitioner for a thorough exam. If there’s an infection, it should be treated. If there’s a condition, it should be diagnosed. There are so many safe plans and products to help maintain a healthy vagina in menopause, but any plan should start with a checkup!

Resources

1. Russo R, Edu A, De Seta F. Arch Gynecol Obstet. 2018; 298(1):139-145

2. https://www.medicalnewstoday.com/articles/321537