Focus on Vaginal Health: Self-Care During and After Menopause

During our reproductive years, we tend to be very focused on preventing pregnancy, preventing STDs, getting pregnant or being pregnant.  But once we go through menopause, much of our health care needs change.

Our focus shifts towards preventing and detecting diseases such as heart disease, diabetes, and various cancers that become more prevalent with age. So, accordingly, our annual health maintenance exams change, too. You may have heard that cervical cancer screening recommendations have changed dramatically over the years, meaning many women only need a pap smear (with screening for high-risk HPV) every 5 years. That is because cervical cancer becomes less common as we get older (after your 40s.)  That being said, there is much more to a pelvic exam than just the pap. Even if you don’t need a pap, we do recommend a gynecological exam every year to monitor for various health concerns such as incontinence, pelvic organ prolapse, vaginal atrophy, menopausal symptoms, breast and pelvic masses, as well as breast, uterine, ovarian, and colon cancers.

As the hormonal environment dramatically changes, so does the vaginal discharge and tissue quality in the vagina after menopause.  With less estrogen, discharge becomes thicker and more scant, and the odor may change.  Likewise, the tissues of the vagina and vulva become more thin and dry.  This can result in a variety of symptoms such as dryness, irritation, and odor which can be entirely normal, or could be a sign of certain common conditions such as bacterial or yeast infections, atrophic vaginitis, or other dermatologic conditions such as lichen sclerosis.  An exam with an experienced health care provider can help you to distinguish normal postmenopausal change from abnormal conditions.

Many women turn to over-the-counter products to try to manage these symptoms.  While some products may provide temporary relief from dryness and odor, many may contain substances that are irritating to the delicate and increasingly sensitive tissues of the vagina and vulva.

Previous generations were encouraged to use douching as a means to control some symptoms but today douching is specifically NOT recommended as this may push bacteria higher into the genital tract.  If your symptoms do not improve fairly quickly, or if they worsen with the use of over-the-counter products, it’s important to get evaluated by a professional to determine the source of the symptoms and best treatment options.

Vaginal atrophy is an extremely common condition affecting up to 50% of postmenopausal women.  This is the thinning and scarring of the vaginal tissue due to lack of estrogen, which typically causes dryness and itching.  This can have profound impact on daily quality of life, as well as interfere with sexual function.  Over-the-counter lubricants and vaginal moisturizers can alleviate these symptoms for many women.  The use of hormone replacement, especially topical intravaginal estrogen, is a very effective treatment for more severe cases that are unresponsive to more conservative measures.  Ultimately, there is not necessarily a way to prevent atrophic changes, but early recognition and early treatment are paramount for preventing more severe scarring and symptoms later.

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