By Chris D. Meletis, N.D.
If you suffer from vaginal dryness—also called vaginal atrophy or atrophic vaginitis—you know firsthand it’s not fun. Often, the first symptom indicating you even have this problem is painful sex. This can really dampen your libido and even make you fear intimacy with your partner.
If misery does indeed love company, the statistics will comfort you. A year after menopause, an estimated 62% to 67% of women have vaginal dryness.1 Up to 85%.1 will be affected by the time they are several years beyond menopause.
You don’t need to be going through menopause to suffer from vaginal dryness. Chemotherapy for anal cancer, estrogen-lowering treatments for breast cancer, or removal of the ovaries or hysterectomies can also lead to vaginal atrophy. And certain diseases such as Sjögren’s Syndrome are linked to this disorder.2 I also see these challenges in some peri-menopause women that are starting to experience changes in their cycle as they approach menopause.
Even though vaginal dryness is really common, sadly only 20% to 25% of women with symptoms actually seek treatment for it.3,4 Many women don’t talk to their doctors about it because they are embarrassed, don’t want a pharmaceutical remedy, or simply accept it as a condition they don’t need to treat.
What is the Genitourinary Syndrome of Menopause?
Vaginal dryness is really part of a larger problem that scientists call the genitourinary syndrome of menopause. Symptoms of this syndrome include not only vaginal atrophy but also itching, burning, vaginal discharge, bleeding after sex, painful urination, and urinary incontinence.3, 5,6
The genitourinary syndrome of menopause happens when your estrogen levels drop over time. The health of the mucous membranes of the urogenital tract (the urinary and genital organs) is dependent upon estrogen levels. Higher estrogen levels are linked to a greater blood supply to the vaginal mucosa, keeping this area lubricated.4 Estrogen can also strengthen the vaginal wall in part through building collagen levels.4 When estrogen levels drop, the vaginal wall becomes thinner. In other words, it atrophies.
Dropping Estrogen Levels Harm Friendly Vaginal Bacteria
The vaginal bacteria—known as the microbiota—pay a price for the drop in estrogen levels that happens after menopause or even after anti-estrogen cancer therapy or removal of the uterus or ovaries. In women who have not gone through menopause, the friendly probiotic bacteria Lactobacillus outnumbers other species.6 These bacteria make lactic acid, which keeps the vaginal fluid at a low pH.6 This protects against urogenital tract infections.6 After menopause or estrogen-lowering therapy, the types of vaginal bacteria can change so that Lactobacillus is no longer the main type.6 This can change the pH of vaginal fluid and lead to vaginal atrophy and the other symptoms of genitourinary syndrome of menopause.6 On the other hand, synthetic hormone replacement therapy (HRT) is known to increase the dominance of Lactobacillus in the vaginal microbiota. This is often associated with reduced vaginal atrophy.7
How Safe is Hormone Replacement Therapy (HRT)?
Although synthetic hormone replacement therapy (HRT) can help reduce vaginal dryness, it causes harmful side effects such as vaginal bleeding and breast pain. In addition, women with a history of breast cancer, or those women with coronary artery disease, active liver disease, and/or who’ve had a stroke should not undergo HRT.8
What Are the Natural Solutions for Vaginal Dryness?
Natural vaginal lubricants are a safe and effective solution for vaginal dryness. Using lubricants that biomatch the vaginal ecosystem and don’t contain harmful ingredients like parabens or phthalates is a supportive way to moisten vaginal walls. Vaginal moisturizers are also able to reduce vaginal pH.4
Choose lubricants and vaginal moisturizers that contain lactic acid. As I mentioned earlier, low estrogen causes a drop in your levels of lactic-acid producing Lactobacillus bacteria. This decline in lactic acid increases the risk of infections and vaginal dryness. Caprylyl glycol is a moisturizing agent considered to be safe and non-toxic by the Environmental Working Group.9 Salvia sclarea (Clary sage) is another great addition to a lubricant. In cell culture studies, it destroyed the cell membranes of Candida albicans,10 the yeast that causes vaginal yeast infections, and E.coli, which can cause urogenital infections.11
Lubricant + Probiotics + Phytoestrogens = A More Comfortable Menopause
Combining a lubricant with dietary supplements containing Lactobacillus probiotics and phytoestrogens is a great way to support health during menopause. For example, red clover may reduce vaginal dryness.12 Maca may reduce a number of menopausal symptoms.13
Licorice and hops both support healthy estrogen levels and therefore may make menopause easier.14 Research has shown that hot flashes don’t last as long after supplementing with licorice.15 By reducing discomfort, all of these ingredients can improve sleep. And the sleep-deprivation that occurs during menopause can actually make vaginal dryness worse.16
Whether it’s called vaginal dryness, the genitourinary syndrome of menopause, vaginal atrophy, or atrophic vaginitis, it’s a frustrating and painful condition. It can seriously dampen your ability to enjoy life. However, using a safe, natural lubricant and taking phytoestrogens and Lactobacillus probiotics, can keep you comfortable and happy.
About Dr. Meletis
Dr. Meletis is an internationally recognized naturopathic physician, an accomplished author, and respected educator in the field of natural medicine. Dr. Meletis was honored as a ‘Naturopathic Physician of the Year’ by the American Association of Naturopathic Physicians for his commitment to education and helping those in need. His mission is simply, “changing the world’s health, one person at a time”.
He has authored 14 books on subjects ranging from natural medicine interactions to fertility enhancement and has published over 80 articles in publications such as Natural Health andNatural Pharmacy. Dr. Meletis has served as the Dean of Naturopathic Medicine and Chief Medical Officer for the National College of Naturopathic Medicine (NCNM) for seven years and later as the school’s Senior Science Officer. He sits on several medical advisory boards and has worked with Oregon Health and Science University on a grant from the National Institute of Health to further educate MD graduates on natural medicine.
- Cagnacci A, Carbone MM, Palma F. Prevalence and association between objective signs and subjective symptoms of vaginal atrophy: the AGATA study. Menopause. 2016 Oct;23(10):1139-45.
- van der Meulen TA, van Nimwegen JF, Harmsen HJM, et al. Normal vaginal microbiome in women with primary Sjögren’s syndrome-associated vaginal dryness. Ann Rheum Dis. 2019 May;78(5):707-9.
- Gupta N, Aggarwal M, Sinha R, Varun N. Study on Prevalence and Severity of Urogenital Complaints in Postmenopausal Women at a Tertiary Care Hospital. J Midlife Health. 2018 Jul-Sep;9(3):130-4.
- Naumova I, Castelo-Branco C. Current treatment options for postmenopausal vaginal atrophy. Int J Womens Health. 2018 Jul 31;10:387-95.
- Cagnacci A, Xholli A, Sclauzero M, et al. Vaginal atrophy across the menopausal age: results from the ANGEL study. Climacteric. 2019 Feb;22(1):85-9.
- Brotman RM, Shardell MD, Gajer P, et al. Association between the vaginal microbiota, menopause status, and signs of vulvovaginal atrophy. Menopause. 2014 May;21(5):450-8.
- Muhleisen AL, Herbst-Kralovetz MM. Menopause and thevaginal Maturitas. 2016 Sep;91:42-50.
- North American Menopause Society. The 2012 hormone therapy position statement of: The North American Menopause Society. Menopause. 2012 Mar;19(3):257-71.
- Environmental Working Group. EWG’s Skin Deep® Cosmetics Database. Caprylyl Glycol. https://www.ewg.org/skindeep/ingredient/701067/CAPRYLYL_GLYCOL/ Accessed May 6, 2019.
- Blaskó Á, Gazdag Z, Gróf P, et al. Effects of clary sage oil and its main components, linalool and linalyl acetate, on the plasma membrane of Candida albicans: an in vivo EPR study. Apoptosis. 2017 Feb;22(2):175-87.
- Cui H, Zhang X, Zhou H, et al. Antimicrobial activity and mechanisms ofSalvia sclarea essential oil. Bot Stud. 2015 Dec;56(1):16.
- Dizavandi FR, Ghazanfarpour M, Roozbeh N, et al. An overview of the phytoestrogen effect onvaginal health and dyspareunia in peri- and post-menopausal women. Post Reprod Health. 2019 Mar;25(1):11-20.
- Meissner HO, Kapczynski W, Mscisz A, Lutomski J. Use of gelatinizedmaca (lepidium peruvianum) in early postmenopausal women. Int J Biomed Sci. 2005 Jun;1(1):33-45.
- Hajirahimkhan A, Simmler C, Yuan Y, et al. Evaluation of estrogenic activity oflicorice species in comparison with hops used in botanicals for menopausal symptoms. PLoS One. 2013 Jul 12;8(7):e67947.
- Menati L, Khaleghinezhad K, Tadayon M, Siahpoosh A. Evaluation of contextual and demographic factors onlicorice effects on reducing hot flashes in postmenopause women. Health Care Women Int. 2014 Jan;35(1):87-99.
- Lee DM, Tetley J. Sleep quality, sleep duration and sexual health among older people: Findings from the English Longitudinal Study of Ageing. Arch Gerontol Geriatr. 2019 May – Jun;82:147-54.