The menopause & vaginal atrophy: symptoms, causes & solutions
Monday, 28 December, 2020

The menopause & vaginal atrophy: symptoms, causes & solutions

Falling oestrogen levels associated with the menopause can cause the vagina cell walls to become thinner, less lubricated and more prone to damage — known as vaginal atrophy. Symptoms include vaginal soreness, itching, burning and pain. Communication, moisturisers and taking care of your vaginal microbiome are key to managing the issue.


Hot flushes, night sweats, mood swings, low sex drive, weight gain — there are 34 symptoms commonly associated with the menopause, and it can truly be a rollercoaster for our bodies and emotions.

So, it really doesn’t seem fair that once women make it through the other side of the menopause, there can be a number of vaginal issues present themselves.

You are officially classed as postmenopausal when you have been free from periods for 12 months or longer. But, before you breathe a sigh of relief, be braced for some potentially uncomfortable changes within your vagina.

But what is vaginal atrophy? Postmenopausal atrophic vaginitis — to give it its official name — one thing we should be ready to expect as we exit the menopause.

Here’s the lowdown!

What is vaginal atrophy and what causes it?

Known as ‘atrophic vaginitis’, vaginal atrophy refers to a collection of vaginal health concerns including dryness, inflammation and thinning of vaginal cell walls as a result of low oestrogen levels.

If you’re approaching the latter stages of the menopause process, you’ll be very familiar with oestrogen. The female sex hormone plays a big part in the physical, psychological and emotional symptoms of the menopause, but also has a key role in vaginal health.

Oestrogen keeps the cells of the vagina wall healthy and lubricated. So, when levels begin to fluctuate during and after the menopause, these cells become thinner, damaged and drier.

Vaginal atrophy symptoms — what are the signs?

  • Vaginal soreness, itching and burning
  • Burning on urination
  • Pain or discomfort during sexual intercourse
  • Spotting after intercourse
  • Slight vaginal discharge
  • Frequent vaginal infections

It’s far more common than you might think; one study estimates that around half of all postmenopausal women experience some symptoms of vulvar and vaginal atrophy.

To refer to all of the symptoms of vaginal atrophy including urinary problems, many medical professionals prefer the more inclusive term ‘genitourinary syndrome of menopause’ (GSM).

By far the most common symptom is vaginal dryness, affecting approximately half of post-menopausal women between ages 51 and 60.

So, be prepared and comfortable discussing vaginal oestrogen creams with your doctor, and be sure to shop for lubricants and natural water-based moisturisers for vaginal dryness. It’s also advised to wear cotton underwear and avoid irritants like soaps and chemical-based femfresh products.

Vaginal atrophy — the role of your vaginal microbiome

Just like the gut, the vagina has its own microbiome which contributes to its overall health and wellbeing.

Before the menopause, the mucus secreted by cells in the cervix and vagina wall keeps the vagina clean, moist and fresh. This mucus also functions to keep the pH at a slightly acidic level — providing a perfect environment for a healthy vaginal microbiome to flourish.

However, as oestrogen levels fall during the menopause, vaginal cells become thinner, less mucus is produced and the pH in the vagina changes. This means that vaginal infections, discharge and frequent urinary tract infections (UTIs) can start to occur.

To help to re-balance the vaginal microbiome, there are some natural lubricants and vaginal pessaries. These contain live bacteria, such as lactobacillus acidophilus, and work to soothe vaginal irritation and provide female freshness and comfort.

Uncomfortable sex during the postmenopause

As it becomes more difficult for vagina cells to produce the extra lubrication needed for smooth intercourse, one of the key vaginal atrophy symptoms is dryness. This can, of course, interfere with sex, and our enjoyment and willingness to have it.

Indeed, approximately one in four women aged between 50 and 59 report that things are a bit drier than they used to be down there during love-making. For between 17 and 45 percent of menopausal women, penetration can be painful, even possibly leading to slight bleeding and a burning sensation.

To help alleviate these vaginal atrophy symptoms, the use of water-based lubricants and natural vaginal moisturisers offer an effective, straightforward solution.

It’s even thought that regular sex can help with the symptoms of vaginal atrophy — sexual activity increases and stimulates blood flow to your vagina, keeping everything healthy.

Communication is key — the CLOSER study

In an international survey of 4100 postmenopausal women and their partners, people were asked to talk about how vaginal atrophy impacts on their intimate relationship.

The results revealed that 28 percent of women hadn’t told their partners that they experienced vaginal discomfort due to embarrassment, or thinking it was just part of getting old.

However, many of the men were more comfortable talking about vaginal atrophy than the women; 82 percent of blokes wanted their partner to share their experiences about this subject!

So, as challenging a topic as it may be to broach at first, let your partner know what you are experiencing, and that it’s simply a part of the menopause. This will allay any concerns or worries that feelings towards them may have changed.

An open discussion can be very reassuring for both of you.

Supporting yourself through the postmenopause

Postmenopausal atrophic vaginitis. A potentially frightening medical term — but nothing, in reality, to be afraid of.

Whilst it can present challenges, dryness is simply an unavoidable part of the postmenopause. It’s certainly no excuse whatsoever for dampening the flame of intimacy in your relationship.

As well as talking to your partner, make sure to explore the range of natural lubricants out there, safeguard your microbiome and don’t be afraid to talk to your GP about your vaginal atrophy symptoms.

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