Vaginal Dryness & Treatment Options
Key Takeaways
In this video, Dr. Jennifer Roelands, an OBGYN and hormone health expert, addresses the common but often overlooked issue of vaginal dryness during menopause and perimenopause. She explains the biological reasons behind these changes, emphasizing how declining estrogen levels affect tissue thickness, lubrication, and pH balance.
Dr. Roelands provides a comprehensive overview of various solutions, ranging from simple lifestyle adjustments and over-the-counter options to prescription therapies and probiotics, aiming to help women find relief and improve their overall vaginal and urinary health.
The Biological Causes of Vaginal Dryness
- As estradiol levels decline during perimenopause and menopause, the vaginal tissues become thinner and more susceptible to trauma and irritation.
- The lack of estrogen reduces the natural production of lubrication from vaginal cells, leading to discomfort or burning sensations.
- Hormonal shifts change the vaginal pH from acidic to alkaline, which can disrupt the healthy microbiome and decrease beneficial bacteria like lactobacillus.
- These changes often lead to an increase in colonization by harmful bacteria, resulting in more frequent urinary tract infections or bacterial vaginosis.
- While estrogen is a primary factor, testosterone and other androgens also play a significant role in maintaining the health of vaginal tissues.
Lifestyle and Environmental Contributors
- Smoking can negatively impact vaginal tissue health, contributing to increased dryness and irritation.
- Certain medications, such as antihistamines and antidepressants, can cause systemic drying that affects vaginal fluids.
- The use of scented soaps, perfumes, dyes, or douches can further disrupt the delicate pH balance and irritate sensitive tissues.
- Simple choices, such as switching to organic or additive-free products, can help minimize external irritation in the vulvar area.
Over the Counter and Non-Hormonal Solutions
- Lubricants are short-term solutions used during sexual activity to provide immediate comfort, though they do not help the tissue retain moisture long-term.
- Vaginal moisturizers, especially those containing hyaluronic acid, help the mucosa retain moisture and keep the tissue healthy over time.
- Vitamin E and hyaluronic acid can also be delivered through compounded suppositories for those who prefer that application method.
- Natural options like coconut oil can serve as a basic, fragrance-free alternative for moisturizing the vulvar area.
- Specific probiotics containing lactobacillus, D-mannose, and cranberry can support a healthy vaginal microbiome and urinary tract health.
Hormonal and Prescription Treatments
- Vaginal estrogen therapy is a highly effective treatment that comes in various forms, including creams, tablets, and rings.
- Low-dose estrogen creams can be applied directly to the internal vaginal tissue, the urethra, and the vulvar area to restore tissue health.
- DHEA, an androgen, can be used to improve tissue thickness, increase sexual sensation, and potentially enhance libido.
- Compounded options allow for customized doses of estradiol, estriol, or DHEA tailored to a patient’s specific needs and sensitivities.
- Consulting with a healthcare provider trained in menopause care is essential to determine the most appropriate treatment and dosage.
Key Video Highlights
What biological changes cause vaginal dryness during menopause?
[00:42] Vaginal dryness occurs primarily due to a decline in estradiol levels produced by the ovaries. This lack of estrogen causes the vaginal mucosa and underlying tissue layers to thin, reducing natural lubrication and making the area more susceptible to trauma and irritation.
How does the vaginal microbiome change as estrogen levels drop?
[01:38] Estrogen is vital for the health of beneficial bacteria like lactobacillus, which produce glycogen to maintain an acidic environment. When estrogen declines, the vaginal pH becomes more alkaline, leading to a loss of good bacteria and increased colonization of harmful bacteria, which often results in more UTIs or bacterial vaginosis.
What is the difference between lubricants and vaginal moisturizers?
[02:49] Lubricants are short-term solutions used during sexual activity to provide immediate comfort but do not help the tissue retain moisture. In contrast, vaginal moisturizers containing ingredients like hyaluronic acid are designed for regular use to help the mucosa retain hydration and maintain long-term tissue health.
Can testosterone or DHEA help with Genitourinary Syndrome of Menopause (GSM)?
[04:44] Yes, there are androgen receptors in the vaginal tissue. Using vaginal DHEA can improve tissue thickness, enhance sexual sensation, and potentially improve libido; it also works by converting to estrogen locally to support the health of the area.
What lifestyle factors can worsen symptoms of vaginal dryness?
[02:22] Factors beyond hormone levels can exacerbate dryness, including smoking, which affects tissue health. Additionally, certain medications like antihistamines and antidepressants can dry out fluids throughout the body, while scented soaps or douching can disrupt the delicate pH of the vaginal microbiome.
Citations Mentioned
About the Expert
Name: Dr. Jennifer Roelands, MD
Affiliation: Precision Health MD
Profile: precisionhealthandwellness.com
Professional Standing: Dr. Jennifer Roelands, MD, is a board-certified OB/GYN and integrative medicine physician. As the founder of Precision Health MD, she uses a functional medicine approach to help women navigate perimenopause and menopause by addressing root causes of hormonal, metabolic, and gut imbalances with personalized nutrition, lifestyle, and medical interventions.
Full Video Transcript
# Vaginal Dryness in Menopause | Causes & Solutions: Doctor Explained
# https://www.youtube.com/watch/kjMnU7lAkpQ
00:00:00.080 if you’re suffering from vaginal dryness
00:00:01.920 or discomfort down there or maybe you’re
00:00:03.919 getting more UTI then this video is for
00:00:09.679 you let’s talk about the vaginal changes
00:00:12.679 that associated with menopause and
00:00:14.440 dryness specifically I’m Dr Jen welcome
00:00:16.960 back to my channel I’m a hormone and
00:00:18.520 metabolic health expert double boarded
00:00:20.439 objn and Integrative Medicine we’re
00:00:22.519 going to talk about a topic today that
00:00:24.199 just doesn’t get a lot of recognition
00:00:26.240 and that’s vaginal dryness in menopause
00:00:28.439 a lot of women suffer from vaginal in
00:00:30.519 fact probably half of the women that I
00:00:32.840 see in my clinic start having this as an
00:00:35.120 issue even in per menopause and even
00:00:38.320 before per menopause but we’re going to
00:00:40.079 talk specifically about menopause what
00:00:42.360 causes this solutions what to do now so
00:00:45.399 first what is vaginal dryness vaginal
00:00:48.079 dryness is a common symptom women have
00:00:50.320 and it happens when estradi levels start
00:00:52.600 to decline so when you’re going through
00:00:54.440 per menopause and then ultimately
00:00:56.440 menopause your ovarian production of
00:00:58.680 estradi starts to go down and in fact
00:01:01.000 and it becomes even so incredibly low
00:01:03.359 that you don’t have Cycles anymore and
00:01:05.319 that lack of vaginal estrogen causes
00:01:07.840 several things to happen in the vaginal
00:01:09.640 tissues first of all the actual
00:01:11.920 thickness of both the layers below the
00:01:14.119 mucosa and mucosa become less so the
00:01:16.840 tissue becomes thinner it becomes more
00:01:18.960 susceptible to trauma so you can feel
00:01:21.799 more burning sensation or you don’t
00:01:24.240 tolerate sex as much you actually have
00:01:26.680 less lubrication because the estrogen is
00:01:29.520 actually needed for the cells in the
00:01:31.360 vagina to make lubrication so when you
00:01:33.520 don’t have that you have less
00:01:34.720 lubrication you also have changes in the
00:01:37.560 vaginal pH because the bacteria in the
00:01:39.799 vagina specifically lactobacillus they
00:01:42.320 make glycogen which actually helps
00:01:44.360 overall with discharge and with
00:01:46.960 lubrication and when that happens it
00:01:49.280 changes the ph and instead of being the
00:01:51.240 nice acidic environment that it was it
00:01:53.079 becomes more alkaline so you actually
00:01:54.920 have less colonization of the good
00:01:56.840 bacteria and start having colonization
00:01:58.799 of the bad bacteria hence why women
00:02:00.960 start noticing they have more UTI or
00:02:03.079 bacterial vaginosis when they go through
00:02:04.840 menopause so estradi is incredibly
00:02:07.560 important for the normal health of the
00:02:10.239 vaginal tissues and I don’t want to say
00:02:11.959 it’s just estrad because testosterone or
00:02:13.959 androgens are also incredibly important
00:02:16.319 in that area but specifically we’re
00:02:17.959 going to focus on estrogen so other
00:02:20.080 factors that can actually make vaginal
00:02:21.840 dryness worse believe it or not smoking
00:02:24.160 not just affects your lungs but actually
00:02:25.879 affects the vaginal tissue as well
00:02:27.680 medications like antihistamines and
00:02:29.360 anti-pr pressence can cause drying of
00:02:31.160 the fluids everywhere in your body but
00:02:32.760 also the vaginal fluids and then using
00:02:34.680 scented soaps or douches can also
00:02:36.920 disrupt the pH to the vagina which can
00:02:39.239 lead to dryness issues as well so
00:02:41.120 knowing the cause helps you find the
00:02:43.040 right solution so how do you treat
00:02:44.720 vaginal dryness okay so for this part
00:02:47.000 let’s talk specifically about different
00:02:49.040 options that can be used first of all
00:02:50.959 there’s always over-the-counter
00:02:52.159 lubricants so lubricants are very
00:02:54.440 different than moisturizers so
00:02:56.760 lubricants are just helping to lubricate
00:02:59.080 the tissue they’re kind of a small
00:03:01.040 simple moment solution right it’s not
00:03:03.480 going to actually help you retain
00:03:04.640 moisture but used often during sex to
00:03:07.040 help make sex more comfortable and most
00:03:09.640 importantly to check on making sure that
00:03:11.400 you’re using lubricant that doesn’t have
00:03:12.959 a bunch of extra stuff in it perfumes or
00:03:15.319 dyes or scents because that can really
00:03:17.519 cause the vaginal tissues to be
00:03:18.920 irritated vaginal moisturizers this is
00:03:21.239 my favorite it’s called vag of Honor
00:03:23.120 from I am Stripes what’s so great about
00:03:25.040 this is it has hyaluronic acid it has
00:03:27.560 moisture it gives you moisture it
00:03:29.280 retains moisture and then it helps with
00:03:31.319 the vaginal mucosa tissue to make sure
00:03:33.640 that that tissue is staying nice and
00:03:35.439 healthy and then if you combined it with
00:03:37.080 like estrad and the vagina that’s like
00:03:39.720 the best combination so this is one of
00:03:41.640 my favorites I also will tend to do
00:03:43.959 compounded suppositories for patients
00:03:45.879 who maybe don’t want to use vaginal
00:03:47.519 Moisturizer in this form but maybe want
00:03:49.319 a suppository and you can use vitamin E
00:03:51.519 hyaluronic acid and estrad in a
00:03:53.439 suppository so estrogen therapy like I
00:03:55.799 mentioned is also very useful for
00:03:57.319 dryness and I did a whole video on B
00:03:59.799 vaginal estrogen so check that out if
00:04:01.640 you want to know specifically about the
00:04:03.680 different types but vaginal estrogen
00:04:05.959 comes in a lot of different varieties
00:04:07.640 you can use the cream which is called
00:04:09.760 estrace and you just put a psize amount
00:04:12.000 on your finger and just go right into
00:04:14.000 the vagina it can be put right
00:04:15.480 underneath the urethra and right on the
00:04:17.040 vvar tissues as well you can also use
00:04:19.160 the estring or vaginal tablet uh called
00:04:22.880 uaam or vagifem and then there’s clearly
00:04:26.040 compounding options too that can be used
00:04:28.199 with both estriol you can add DHEA you
00:04:31.440 can make estradi I you can make anything
00:04:33.600 on compounding and I tend to do that if
00:04:35.639 women have tried these products and it’s
00:04:37.560 not seem to be working or they need
00:04:39.240 something a much smaller dose or dose
00:04:41.800 specific for them so you can also use
00:04:44.360 vaginal DHEA so DHEA is an androgen and
00:04:49.240 there are Androgen receptors in the
00:04:51.120 vagina and that can improve vaginal
00:04:53.280 tissue the thickness improve sexual
00:04:56.360 sensation sometimes even improve libido
00:04:58.680 some women have described it actually
00:05:00.160 helps with libido and it works by also
00:05:02.400 helping with conversion to estrogen
00:05:04.120 locally as well and then lastly a good
00:05:06.759 healthy microbiome is really really
00:05:09.240 critical so the vaginal tissue needs to
00:05:11.320 also be full of good blood flow plump
00:05:13.720 and working but you also need to have
00:05:15.520 good bacteria and the vagina also needs
00:05:17.440 to be acidic so I often recommend
00:05:19.759 probiotic that has specific strains for
00:05:22.400 the vagina and I like the vaginal
00:05:24.240 Wellness Pro from Physician’s choice
00:05:26.160 because it not only has the right type
00:05:28.240 of lactobacillus but also it has de
00:05:30.960 Manos and cranberry which can be great
00:05:32.840 for urinary Health as well lastly I do
00:05:35.160 want to say that some women actually get
00:05:36.600 a lot of benefit from using vulvar bombs
00:05:38.639 because if you’re having vaginal dryness
00:05:40.160 you might have vulvar dryness or you may
00:05:41.720 have a condition like lyan sclerosis
00:05:43.720 where you’re tend or lyan plainness
00:05:45.000 where you tend to have more tissue
00:05:46.880 that’s dry so I often will recommend
00:05:49.400 vulva bomb I like this one from medicine
00:05:51.600 Mama because it’s organic it’s very
00:05:53.680 simple you don’t want a lot of things to
00:05:55.560 cause irritation but you can also go as
00:05:57.800 basic as just using coconut oil in that
00:05:59.680 that area and that’s okay too so make
00:06:02.120 sure you find something that’s actually
00:06:03.880 doesn’t have a lot of scents or perfumes
00:06:05.800 or dyes or additives because that will
00:06:07.960 really cause more issues so those are
00:06:10.080 some options on how to treat vaginal
00:06:11.800 dryness remember all of these you should
00:06:13.440 consult with your physician because you
00:06:14.759 want to make sure you’re taking the
00:06:15.840 right thing for you and you want to make
00:06:17.400 sure you’re taking the right dosage so
00:06:18.880 it’s important to make sure you consult
00:06:20.319 with your healthcare provider lastly I
00:06:21.960 just want to say you know it’s a very
00:06:24.000 common problem to have vaginal dryness
00:06:25.800 and you’re not alone there are a lot of
00:06:27.240 women in fact one and two women have
00:06:28.880 vaginal dryness they go through
00:06:30.000 menopause and it’s really important to
00:06:31.639 know that there are options for you you
00:06:33.560 don’t have to suffer and you don’t have
00:06:35.520 to feel alone cuz there are women who
00:06:37.639 can help you and providers who are
00:06:39.479 trained in menopause care to help you
00:06:41.520 along your journey so if you like this
00:06:43.520 video please like And subscribe and give
00:06:45.720 me some comments let me know what’s
00:06:46.840 worked for you I know there are a lot of
00:06:48.280 women who use all kinds of things so
00:06:49.960 throw them in the comments to help other
00:06:51.440 women thank you
00:06:59.600 [Music]
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