Menopause facts: expert guidance on dealing with natural change

Everything is changing, even my vagina is mad at me!

First of all, I would like to spend a few minutes defining this elusive thing called menopause. We will start with the “official” definitions and then talk about what really happens. Menopause is more of a “process” than a single event…

  • Menopause is defined as the time when your menstrual cycles stop permanently and you are no longer fertile. This is diagnosed officially after you have gone 12 months with no menstrual cycles.
  • Perimenopause - the word “perimenopause” actually means “around” menopause. This time frame has also been called the “menopause transition” and often gets confused with true menopause. It is hard, because of the unpredictable hormone fluctuations; this is often the time when women first start noticing symptoms. It commonly occurs in our 40’s, but can even start in our mid 30’s. This does not mean you are in menopause if you are still having menstrual cycles. It is common for women to notice symptoms due to the uneven rise and fall of hormones during these years. You may even experience menopause-like symptoms, such as hot flashes, night sweats with sleep disturbances, and even vaginal dryness


Vaginal changes in menopause

The hormone estrogen helps maintain that fluid and keeps the lining of the vagina healthy, thick, and elastic. During menopause, the drop in estrogen levels reduces the amount of moisture available. It also makes the vagina thinner and less elastic. This is called vaginal atrophy.

WHY does this happen?

Before menopause the hormone estrogen helps to keep the tissue that lines your vagina healthy, moisturized and elastic. There are special glands in your vaginal that secrete fluids and mucous to keep it moist. The estrogen your body produces each month stimulates these glands helping them to provide lubricant and keep the vaginal tissue healthy. The estrogen produced by your body also helps keep you PH acidic and encourages the “good bacteria” to stick around helping protect you from vaginal infections.

After menopause, your ovaries make much less estrogen and this can affect MANY things, as most women know including your vagina. This drop in estrogen concentration leads to what we call a “hypoestrogenic” state meaning “low” estrogen. There are other things other than menopause that can cause this such as breastfeeding and certain medications. These changes usually happen very gradually over a period of time. This can lead to both vaginal and urinary symptoms.


Changes in the vagina that happen from the low estrogen are:

  • Less vaginal secretions from the vagina leading to a “dry” feeling
  • Increase in PH making the vagina less acidic and more prone to infections
  • Decreased elasticity of the tissue, meaning the tissue does not “stretch” as well
  • Thinning of the top layer of epithelial cells (tissue lining the vagina) making the tissue more fragile and prone to tearing, burning, irritation.

The medical term for these changes is “Vulvovaginal atrophy” or “postmenopausal atrophic vaginitis”

Symptoms of atrophic vaginitis…

Common symptoms of postmenopausal vaginal atrophy include:

  • Vaginal dryness
  • Vaginal itching
  • Burning sensation
  • Painful intercourse
  • Urinary symptoms (urgency, recurring UTI’s)

Most of these symptoms come on gradually over time. Not everyone has ALL these symptoms, but these are the most common. There are many treatments available and treatment depends on your specific symptoms. Treatments include vaginal moisturizers, lubricating gels, vaginal estrogen.

Much like we use moisturizer to keep our skin from getting dry, there are many vaginal lubricants and “moisturizers” available without a prescription. These can help relieve pain during intercourse for many women.


Vaginal lubricants are used during sexual intercourse to relieve some of the friction that is painful due to the dryness of the vaginal tissue. The purpose of the lubricant is to reduce skin friction and therefore irritation during intercourse. There are MANY lubricants to pick from. Especially if you are sensitive it is important to pick one that is free of fragrance, flavors, heat causing agents, alcohol that can be drying, or parabens. These chemicals can cause irritation.

Vaginal Moisturizers

Vaginal moisturizers can also reduce painful friction of sexual intercourse by adding moisture back into the tissue. These work differently than lubricants in the fact that they are absorbed into the tissue and cling to the walls of the vaginal for several days. Another difference is that vaginal moisturizers are applied regularly to help maintain moisture, not just before sex. Think of them as applying lotion to your skin.

Low dose vaginal estrogen

These postmenopausal vaginal changes occur as a result of decreasing amounts of estrogen. If lubricants and moisturizers are not enough to relieve these symptoms, you may want to talk with your doctor about vaginal estrogen. Estrogen products developed for localized vaginal use can actually act to reverse some of these vaginal tissue changes, restore blood flow, and return elasticity and moisture to the tissue. These products treat the cause, not just the symptom.

Vaginal estrogen is available in several different formulations and does require a prescription from your provider. If you are experiencing symptoms, it is important to talk to your provider to see if you are a candidate for this therapy.

Below is a list of just a few of the popular vaginal moisturizers and lubricants available:


  • Replenz
  • Me again
  • Vagisil feminine moisturizer
  • Feminease
  • K-Y Silk-E


Water Based

  • K-Y jelly
  • Astroglide (also comes in sensitive skin formula)
  • Slippery stuff
  • Liquid silk

Silicone based

  • Astroglide X
  • K-Y Intrigue
  • Pink
  • ID Millennium

*When choosing a lubricant for very sensitive skin it is best to avoid lubricants containing the following products:

  • Spermicide- contains nonoxynol-9 that can be very irritating to sensitive skin
  • Capsaicin- ingredient used in many of the “warming” lubricants
  • Glycerin- contains sugar and can promote yeast growth in women who are prone to infections. Women who are not prone to yeast infections can use it successfully.
  • Parabens- added to decrease bacterial growth in products and prolong shelf life, but can be irritating to sensitive skin

Sensitive skin lubricants:

  • Astroglide sensitive skin
  • Wet naturals
  • Liquid silk
  • Coconut oil- this is another great option of an “all natural” product that has a low likelihood of irritation to sensitive skin. However, it CANNOT be used with latex condoms, as it will break them down.