Women sometimes notice changes to their body as they approach menopause. Some common physical changes can include breast tenderness, heart palpitations, and weight gain. Other menopause-related changes and symptoms can affect the vulvar region – or the external area of the female genitals – as well as the vagina – and can present as annoying, disconcerting itching.1
“Vaginal itching is very common during menopause, and it’s one of the most common complaints from women in this stage of life,” says Dr. Nancy Kimber, MS, MD, FACOG. Dr. Kimber adds that while women of all ages can experience vulvar and vaginal itching, it may become more common or intense as they approach menopause.
How Do Hormones Affect Vaginal or Vulvar Irritation During Menopause?
Like many other menopause symptoms, vaginal itching during menopause is often due to shifting hormones. Estrogen levels tend to drop during this time, which causes the vaginal lining to become thinner and dryer. This condition is often referred to as atrophic vaginitis, vaginal atrophy or by its new, more encompassing term, Genitourinary Syndrome of Menopause (GSM). Estrogen also helps to keep skin healthy by stimulating the production of natural oils and collagen—a protein that is responsible for skin elasticity—so when estrogen levels fall, skin irritation and itching may result. While dry skin can occur on any area of the body during menopause, it can be particularly irritating for sensitive regions like the vulva and vagina.2
Causes of Vaginal Itching: Is it Always Related to Menopause?
Vaginal itching tends to be more common during menopause, but that doesn’t always mean menopause is the direct cause. While an onset of vaginal or vulvar itching in a woman’s 40s or 50s is possibly related to body changes experienced during menopause—58% percent of women experience dry, itchy skin from head to toe during this time—so, there are also other factors that can cause vaginal irritation and itching.3 Aside from menopause-related hormone fluctuations, other possibilities contributing to vaginal and vulvar irritation during menopause can include:
“An imbalance in the vaginal microbiome can sometimes trigger an infection,” cautions Dr. Kimber. The vagina hosts naturally-occurring fungi called Candida, and if there is overgrowth, irritation and a clumpy white discharge – as well as intense itchiness of the vagina and vulva – can result. The good news is that yeast infections are most-often easily treated by a medical professional.4
Yeast infections are sometimes caused by the antibiotics we take to treat other infections, like bronchitis or a sinus infection. This can coincide with an increase in vaginal itching following the course of antibiotics. This happens because, while antibiotics are designed to kill the harmful bacteria that are causing your initial infection, they can also attack good bacteria (i.e., the kind that helps maintain balance in our vaginal microbiomes, known as the lactobacilli strain). Over-the-counter antifungals are available to treat these secondary yeast infections, but it’s always a good idea to check in with your healthcare provider first before self-treating. Additionally, avoiding unnecessary antibiotics may also help prevent yeast infections—and the vaginal itching that accompanies them—in the first place.5
Do you remember studying pH balances – a method for measuring of how acidic or alkaline a substance is – in high school chemistry class? Well, the vagina has pH levels too, and they need to stay balanced in order to maintain good health. Shifting hormone levels during menopause can disturb the vagina’s delicate pH balance. And when vaginal pH levels get out of sync, an infection called bacterial vaginosis (BV) may occur.6
Signs of BV include: 7
- Itching and redness in the vulvovaginal area
- A “fishy” odor that may worsen after intercourse
- A burning sensation with urinating
- Grayish-white or yellow vaginal discharge
While BV symptoms are rarely serious, if left untreated, it can weaken vaginal tissue and increase the risk of sexually transmitted diseases. Antibiotics, such as metronidazole and clindamycin, are used to treat BV and can be prescribed by a healthcare provider.8
Vaginal itching may be a symptom of some sexually transmitted diseases (STDs), as well. Some of the more common STDs include chlamydia, genital herpes, genital warts, trichomoniasis, and gonorrhea. It’s important to have any unusual odor, discharge, itching or noticeable changes in the vaginal or vulvar area checked out, especially if it is a new symptom or set of symptoms, or if you have a new sexual partner. Treatment for most STDs typically include a course of antibiotics or anti-parasitics.9
While relatively uncommon, vulvar cancer can cause vulvar itching. Other symptoms of vulvar cancer can include abnormal pain or bleeding. If you’re concerned about any new symptoms you’re experiencing, or if a history of cancer runs in your family, it’s recommended that you check-in with your healthcare provider to determine what may be causing your symptoms. Treatments for vulvar cancer are available and have a high success rate when diagnosed early.10
Other Causes of Vaginal Itching During Menopause
Wearing tight or wet clothing, sweating, and allergic reactions to heavily fragranced soaps and detergents are other common causes of vaginal itching during menopause. These types of “contact” irritation may happen at any age, however, and are not typically considered to be menopause-specific.11 Other conditions, such as eczema, psoriasis and lichen sclerosus may also be at the root cause of itching, so it’s important to check with your healthcare provider to determine what’s causing the symptom.
How to Treat Vaginal and Vulvar Itching
Dr. Kimber says that women don’t have to suffer from itching, and she explains her process for treating her patients: “First I establish where the symptoms are being experienced: internally, externally or both,” she says. “I then discuss the treatment options, which can include natural oils (coconut, emu, pomegranate), in addition to over the counter, hormone-free options, as well as prescription choices, either localized or systemic.”
Preventing Vaginal Itching
No matter what stage of life vaginal or vulvar itching arises, several things can be done to avoid irritation, including:12
- Staying hydrated
- Wearing undergarments made with breathable fabrics, like cotton
- Using unscented soaps, lotions, and bubble baths
- Changing out of wet or damp clothing promptly
- Avoiding very hot baths, which can dry out skin
- Eating yogurt with live, active cultures or taking a high-quality probiotic to maintain balance in your vaginal microbiome
Most vaginal itching isn’t a cause for concern, but Dr. Kimber urges women who experience it to seek medical treatment, especially if itching is severe or lasts longer than a week. “Symptoms seem to get worse with time, especially if left untreated,” Dr. Kimber adds. “So, I encourage women to feel confident in discussing their symptoms with their healthcare provider so they can get the treatment and relief they deserve.”
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