Going down south

A dry spell can affect your relationship

A dry spell can ruin your relationship
Menopause causes silent suffering

“Many women suffer in silence because it’s embarrassing to talk about,” says gynaecologist and obstetrician, Dr Trudy Smith. “Hormonal changes associated with aging and menopause may affect the lining of the vaginal walls leading to dryness and discomfort.”


Vaginal dryness and thinning of the vaginal wall during menopause can affect as many as 1 out of 2 menopausal women.


Vaginal dryness may be experienced before or during sex; via pain during sex; vaginal itching and burning; itching or irritation of the outer lips of the vagina; frequent or recurring vaginal or urinary infections; or thrush-like symptoms. Because the pH in the vagina changes after menopause, women are also at higher risk of vaginal infections and inflammation.


“It can have a significant negative impact on a woman’s sex life, self esteem and day-to-day quality of living,” says Dr Smith. “It’s a vicious cycle because women with vaginal dryness tend to avoid sex, because it’s painful and uncomfortable and this actually worsens the problem.”


Although inadequate vaginal lubrication can occur at any age, around menopause, women experience a decline in the hormone oestrogen, which can lead to thinning and inflammation of the vaginal walls, called vaginal atrophy – resulting in dryness of the vagina. 


Dr Smith says if the menopausal symptoms are limited to the vaginal area alone, Hormone Therapy (HT) that is applied directly or locally to the vagina, rather than oral therapies designed to treat the entire body, is recommended.


“We find that applying HT locally can help women avoid some of the side-effects associated with systemic HT therapy, because very little gets absorbed into the blood.” says Dr Smith.

She says that vaginal lubricants and moisturisers are sometimes used to treat the symptoms, but these do not treat the underlying cause of the dryness - a lack of oestrogen. “That’s why local vaginal oestrogen therapy is needed.” 


Vaginal oestrogen is available in either a cream or vaginal tablet form, however, the downside of using creams includes the fact that they can be difficult to use, are messy and it’s difficult to get precise dosage levels. Dr Smith says vaginal oestrogen tablets may overcome these problems.


Vaginal oestrogen tablets are inserted deep into the vagina using a single use applicator. The tablets contain oestradiol, a naturally occurring female hormone oestrogen and the tablet exerts its effect locally in the vagina, restoring the thinning vaginal wall to its pre-menopausal state.


The oestrogen in the vaginal tablet also keeps the vaginal pH at the correct level, which supports the normal vaginal flora.


“These tablets work quickly and you should see an improvement within the first two weeks of use,” says Dr Smith. “However, it may take up to 12 weeks to feel the full benefits of the medication.


Vaginal tablets are initially inserted every day for a period of two weeks, thereafter twice weekly insertions are enough to maintain vaginal health. Dr Smith says that women with a uterus taking systemic HT need to take additional progesterone, to prevent endometrial cancer. “But with locally applied HT, such as vaginal tablets, very little oestrogen is absorbed into the rest of the body, so they can avoid taking additional progesterone.”


“It’s important that your doctor conduct an examination regularly to assess whether on-going treatment is necessary,” says Dr Smith. “But it’s good to know that the condition can be treated effectively and women can enjoy an active, loving sex life and day-to-day comfort.”


Oestrogen vaginal tablets are available at your pharmacy without a prescription.


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