Vaginal dryness, also called atrophic vaginitis, is experienced when the vaginal area lacks adequate moisture. Normally the walls of the vagina are lubricated with a thin layer of moisture. Sexual arousal increases blood flow which further stimulates the secretion of fluids, providing extra lubrication. Menopause can cause a disruption in the production of protective fluids in the vagina. This is caused by the depletion of hormones during perimenopause and menopause. Lower estrogen levels causes the walls of the vagina to become thinner; therefore, women are more prone to irritation and discomfort during both sexual intercourse and activities of daily living. Symptoms can range from mild and tolerable to significant and debilitating.
|Common Symptoms of Vaginal Dryness|
Vaginal dryness can be a difficult subject to talk about despite being a common menopausal symptom for many women. Vaginal dryness can have significant impacts on personal relationships, activities, quality of life and sexual function. Unlike other common symptoms of menopause, such as night sweats and hot flashes that can resolve over time, vaginal dryness often requires treatment to resolve.
The most common cause of vaginal dryness in menopausal women stems from the decrease in estrogen levels. This decrease in estrogen can lead to atrophy. Atrophy is when the tissues in the vaginal area, including the vulva, become thinner and drier as secretions are diminished, which also decreases natural lubrication.
It is also important to note that a decrease in estrogen can cause the pH level to change in the vagina. The environment of the vagina is typically more acidic which can help protect from things like bacteria. The decline in estrogen occurs with a correlating increase in pH which can lead to irritation and a higher chance of infection.
|Other Causes of Vaginal Dryness|
|Approaches for Treating Vaginal Dryness|
When considering ways to help treat vaginal dryness, it is wise to start with the options that have the lowest risk of side effects. Lifestyle adjustments are a great first-line option for women as they can be safer and more cost-effective than other treatments.
Implementing a healthier diet, managing stress, and communicating with your partner can be key steps in resolving vaginal dryness.
Things to avoid to help improve symptoms of vaginal dryness include:
Treatments for vaginal dryness, dyspareunia (painful intercourse), and vaginal atrophy (thinning, drying, and inflammation of the vagina due to the loss of estrogen) include topical vaginal estrogen, hormone therapy, vaginal suppositories, personal lubricants, and moisturizers. 
Hormone creams are applied to the vagina and include a medication that requires a prescription. These medications are aimed at restoring the thickness of the vaginal walls, increasing blood flow to the vagina, and helping the vagina to become more flexible and “stretchy”. Ideally, pain and discomfort may be reduced, especially during intercourse.
Hormone treatments generally come in the form of compounded or commercially available creams, tablets, or rings that are inserted into the vagina. Studies have indicated that estrogen creams and rings can work well in relieving vaginal dryness [1, 2]. Vaginal delivery of hormones often does not improve other estrogen-related menopause symptoms such as hot flashes and night sweats because they work in a localized area.
|Examples of Medications for Vaginal Dryness|
|Tablet or Capsule||Ring||Cream|
|Vagifem, Yuvafem, or Imvexxy
|Estring, Femring||Premarin, Estrace|
The pharmacists at Coast to Coast Compounding can discuss various options and pricing for vaginal treatments, including a variety of bases which are specially formulated to be preservative, irritant, and paraben-free.
There are other options that can reduce discomfort and improve the quality of life for women who don’t want to use medications to relieve vaginal atrophy and dryness.
Vaginal moisturizers and lubricants are commonly recommended as a first-line option for women with mild vaginal dryness symptoms.
While both vaginal moisturizers and lubricants are non-hormonal options used to help replenish moisture in the vagina, they have their differences. Knowing how and when to use each one appropriately will help greatly in deciding which one will be right for you.
Vaginal moisturizers can be used regularly to help relieve continuous discomfort from dry, sore, and uncomfortable vaginal dryness, particularly around the vulva. The moisturizing effect can support healthy vaginal tissue and mimic the effects of natural vaginal secretions (which are often greatly reduced during menopause). Moisturizers should be applied at least 2 hours prior to intercourse and are a great option for women who want to have the ability to be spontaneous when it comes to intercourse.
|Examples of Moisturizers|
If sexual intercourse becomes uncomfortable or painful during menopause and is the main issue, vaginal moisturizers alone may not be sufficient to ease it. Many women find that they also need to use lubricants for comfort. This is largely due to having less estrogen, which acts as a natural lubricant in the vagina.  Vaginal lubricants can be used immediately prior to intercourse and reapplied as needed to help increase the amount of moisture and comfort. Unlike moisturizers that can have lasting effects, lubricants are used for moisture needed only for a shorter duration. Lubricants may be water-based, silicone-based, or oil-based.
|Examples of Lubricants|
Elegance Women’s Lubricant
It’s important to choose the right lubricant or moisturizer that fits your needs. Not all lubricants and moisturizers are appropriate for all situations. For instance, oil-based lubricants are not a good option when using condoms or toys in the bedroom. Knowing why you are using them and what results you expect are the most important part of choosing a product that fits your lifestyle.
Supplements and alternative treatments are options for those who want to avoid hormone therapy and still target the root cause of their vaginal dryness. Alternative treatments and supplements can be used to rebalance the hormone changes that contribute to vaginal dryness. Supplements may provide a more simple and convenient method to gaining relief from vaginal dryness. It is important to note that supplements and alternative treatments are not risk-free and you should consult your doctor or pharmacist before starting a new supplement.
|Hormonal||Non-hormonal (lubes & moisturizers)|
|Address the root of the cause for vaginal dryness, hormone imbalance||Can provide extra moisture to aid in relief from vaginal dryness without the use of hormones|
|May or may not be associated with addressing the underlying cause of vaginal dryness by increasing moisture or introducing plant-based estrogens||Personalized medications to meet the needs of individual patients (e.g. preservative- or paraben-free)|
Each of these approaches in relief of vaginal dryness is not exclusive. It is important to take many things into consideration when deciding what is right for you. Some women may find that a combination of options, such as a healthier lifestyle along with alternative therapy is the best and most effective option in dealing with vaginal dryness.