How to Really Manage Vaginal Atrophy at Menopause

By: Red Hot Mamas

Published: October 18, 2010

We all know menopause symptoms can be a real burden. Sure, the hot flashes, night sweats and insomnia are all incredibly unpleasant, but when it comes to vaginal changes at menopause, the symptoms can be downright egregious. Although safe and effective options are readily available to minimize irritation and control the condition, only a small percentage of women (about 25% in the western world and probably considerably less in other areas) will seek medical help. For World Menopause Day, October 18, 2010, the International Menopause Society (IMS) highlights the significance of the condition and offers new Recommendations for the Management of Postmenopausal Vaginal Atrophy.

Vaginal atrophy is a distressing condition that affects up to half of women after they reach menopause. Decreasing levels of estrogen causes changes to the vagina and urinary system at menopause and can cause dryness, irritation, itching and pain with intercourse. Vaginal atrophy symptoms usually don’t just go away like hot flashes, but they persist and even may get worse with time. By maintaining the health of the vagina, vulva and urethra, some symptoms of vaginal atrophy can be minimized or avoided. Here are some helpful home tips from IMS:

  • Wear underpants made of natural fibers such as cotton and change them daily.
  • Avoid, or at least limit, time spent wearing tight-fitting undergarments, pantyhose, jeans or trousers as this may lead to sweating. Also limit time in damp or wet bathing suits or exercise clothing.
  • Wash clothing with non-perfumed or low-allergenic washing products. Avoid use of fabric softeners. Consider second-rinsing if symptoms persist.
  • Avoid use of feminine hygiene sprays and douching. Avoid pads, tampons and toilet paper that are scented.
  • Avoid shaving or waxing the genital area, particularly if irritation is present.
  • Gently wash the skin of the genital area only with plain water. Or, use soap alternatives such as aqueous cream and avoid liquid soap, bubble bath and shower gels. Always pat dry (don’t rub).
  • You can continue to be sexually active and, in fact, it may improve your symptoms. Sexual activities, whether with a partner or masturbation, improve blood flow and help maintain healthy tissue. Consider using a vaginal lubricant or moisturizer.
  • Practice safe sex, unless in a mutually monogamous relationship in order to reduce genital infection.
  • Quit smoking. Smoking increases atrophy by decreasing blood flow to the genital area and directly affecting vaginal cells, as well as threatening your overall health.

Over the counter treatments are also available to soothe symptoms including cool washes or compresses, vaginal moisturizers and vaginal lubricants. Vitamin E and/or natural oils may help, but be wary of tea-tree oil and pawpaw ointment as they can cause greater irritation.

If problems persist or worsen, you may need a prescription medication to really get your symptoms under control. The vaginal area needs a sufficient amount of estrogen to remain healthy. When estrogen levels decrease at menopause, the vaginal lining becomes thinner and drier, a reduced blood supply and reduced lubrication causes the irritating symptoms often experienced. While the aforementioned tips may be helpful, the best treatment for vaginal atrophy is to replenish the adequate levels of estrogen. local estrogen, also called vaginal estrogen.

Hormone therapy in its systemic form (oral tablets) will treat vaginal atrophy, but many women choose to use local estrogen to avoid side effects associated with taking it in pill form. With vaginal estrogen, serious side effects are not common.

Local estrogen, in the form of tablets, pessaries/vaginal creams or vaginal rings can deliver estrogen directly to the vagina. Small doses are all that are usually needed. Refills are often necessary though, because the treatment is only effective while you are using it. It is applied regardless of when you have intercourse. Three to six weeks after initiating the vaginal estrogen regimen, you should begin to feel improvement (in 80-90% of women, this is the case).

Women taking systemic hormone therapy (tablets, patches or gels) who still have a uterus, need to take estrogen with progestogen (combined therapy) in order to reduce the risk of developing cancer in the uterus. If you use vaginal estrogen, but not taking hormone therapy, then you do not need to take a progestogen because the amount of estrogen absorbed is so small.

It’s important for you to talk shop with your healthcare provider. You may think that talking to your clinician is embarrassing, but you need move beyond the awkwardness. Your clinician has heard it all before. Before discussing your symptoms, try to plan ahead for your visit. Keep track of your symptoms, when it hurts, where it hurts, and all other details. Also, share with your clinician the type of and level of discomfort you are experiencing.

If you’re really suffering from vaginal symptoms of menopause, discuss these options with your healthcare provider. Together, you can create a treatment plan to minimize or even completely diminish your discomfort.

For more information about World Menopause Day 2010 and to read Recommendations for the Management of Postmenopausal Vaginal Atrophy, go to:

For more information about sexual health and menopause, go to:



Sturdee, DW, and N Panay. “Recommendations for the Management of Postmenopausal Vaginal Atrophy.”Climacteric. 1.14 (2010): Print.


Vaginal Atrophy- A Change With Menopause.” International Menopause Society, n.d. Web. 14 Oct 2010.