Guest Post By Jane Lewis
My name is Jane Lewis. I am 52 and this is my blog about vaginal atrophy: the very last taboo of menopause.
In fact, it’s so taboo that I have written a book in collaboration with my daughter Penny called Me & My Menopausal Vagina. Vaginal atrophy, which was renamed “urogenital syndrome of menopause (GSM)” in 2014, is actually a pretty common part of the menopause that we are not prepared for or educated about and this must change. Due to an ageing population, this problem will become a potentially big problem, costing the health service huge amounts of money, not to mention the emotional and physical toll on the women suffering and their sexual relationships and lifestyle.
As we age, our friend estrogen that has kept everything supple and lubricated declines a lot…
So, what is vaginal atrophy? As we age, our friend estrogen that has kept everything supple and lubricated declines a lot. This can and does cause a whole host of problems for many ladies, from mental health problems, weight gain, hot flushes, itchy skin and many more problems; however, one of the most common symptoms of the menopause is vaginal dryness. On the surface, it seems doable, like nothing much – but oh dear, this bit of vaginal dryness can and does cause total misery for so many women, and by default their intimate relationships.
Due to this decline in estrogen, the vaginal walls thin and become more fragile, and sex can become painful if not impossible for some ladies. Externally, the vulva area can get very sore, itchy, and you may experience a burning sensation. You can experience repeated UTIs, repeated night trips to the loo, old episiotomies splitting, and micro cuts – all of which are due to reduced estrogen. We are also more prone to prolapses as with the reduction of estrogen the pelvic floor becomes weaker, just as our boobs droop and head south so too can our pelvic floor and the organs within it. Women’s health physiotherapists can help ladies who are leaking urine, and local estrogen can be prescribed by your GP or a medical professional for additional help. For some like myself, HRT is also required.
Vaginas do not need douching: this is a craze that is potentially dangerous. The vagina is self-cleaning and has its own ecosystem!
It’s very important that you do not self-treat from the chemist or supermarket with lotions and potions, some of which contain ingredients that quite simply should not go anywhere in our vagina or on our vulva. Vaginas do not need douching: this is a craze that is potentially dangerous. The vagina is self-cleaning and has its own ecosystem! The reason you should not self-treat is that there are quite a few other vulva skin conditions we can get, that have almost identical symptoms at the beginning as vaginal atrophy, such as lichen sclerosus, but if left untreated can have far worse consequences including vulva cancer. Therefore, we should examine our vulva every month with a magnifying mirror and have a look in all the nooks and crannies. Have a feel for lumps – when you check your breasts, check your vulva also. Get into the habit – it may just save your life. By checking if anything is different from one month to the other, you can spot any changes quickly, so that you can get appropriate medical attention sooner rather than later.
Additionally, you can have vaginal atrophy and lichen sclerosus at the same time. Lichen sclerosus is treated with steroid cream to keep it under control and to try and avoid it turning to vulva cancer (which is very rare but can happen) and it’s important that this treatment is kept up under the care of a specialist. On the other hand, vaginal atrophy has similar symptoms but steroid treatment is not appropriate. The treatment for vaginal atrophy is local estrogen in the form of a cream, ring or a tiny pessary. Vaginal atrophy can’t be cured, and it won’t clear up on its own. It’s a lifetime of management. Some ladies can manage with just a lubricant but local estrogen is really the only treatment that will help with the symptoms long-term as the vagina and vulva need and want estrogen.
…despite the fact that the number of women who will get vaginal atrophy is thought to be 70-80%, only 7-10% will go to their GP.
To be clear, local estrogen is not the same as HRT. Local estrogen is very weak and using it twice a week is the equivalent of one HRT pill a year. Furthermore, the side effects leaflet in the local oestrogen is the same as that in HRT, and can scare some women, but it’s just never had its own leaflet made. Ladies who have had breast cancer can and do use local estrogen under the care of their oncologist, as vaginal atrophy can be a real problem for ladies who have had chemotherapy and using the hormone blocking drugs.
A final thought: despite the fact that the number of women who will get vaginal atrophy is thought to be 70-80%, only 7-10% will go to their GP. This must change, and this side of the menopause must be discussed. So many ladies think they have gone through the menopause, then at their mid-60s this side of the menopause decides to have her last laugh and literally bites you on the backside. So, if you want to learn a lot more about your vagina, vulva, pelvic floor, have a laugh and possibly a cry (especially if a sufferer as you will “get it”), be pushed out of your comfort zone in the bedroom department, and learn about HRT to make an informed choice, then this book is for you.
To learn more about Jane’s book, visit www.mymenopausalvagina.co.uk