To all the women who championed through perimenopause and menopause and have arrived in the postmenopausal years, congratulations! May the days and nights of hot flashes, night sweats, mood swings, and other symptoms be behind you. But some of you may be experiencing a new symptom: vaginal dryness.

What causes vaginal dryness?

During the decades before post menopause, the walls of the vagina are lubricated with a clear fluid. Estrogen is responsible for maintaining the fluid so that your vagina stays elastic, thick, and healthy. However, as estrogen levels begin to decline during perimenopause and menopause, that layer of fluid fades and the vaginal tissues become thinner and more easily irritated.

Vaginal dryness, which is also referred to as vaginal atrophy or atrophic vaginitis, typically begins during menopause, when it affects about one in three women. By postmenopause, the number is even greater, around 50 percent. Many women believe vaginal dryness, as well as the itching, burning, and painful sexual intercourse that often goes along with it is just a natural part of aging. However, “half of women don’t get these symptoms as they age. So it’s not just a part of aging,” notes Dr. Caroline Mitchell, assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School.

Vaginal dryness also can have other causes, which may or may not accompany the decline in vaginal tissue elasticity and moisture. Those causes include:

• Use of cold or allergy medications, some antidepressants, or anti-estrogen drugs to treat endometriosis or uterine fibroids
• Chemotherapy or radiation treatment for cancer
• Surgery to remove the ovaries
• Sjogren’s syndrome
• Douching and use of scented soaps, lotions, and bubble bath products around the vaginal area

The combination of vaginal dryness, irritation, and pain during sexual intercourse is referred to as genitourinary syndrome of menopause (GSM) by the North American Menopause Society and the International Society for the Study of Women’s Sexual Health. Although many menopausal symptoms tend to fade over time, the ones associated with GSM tend to stick around because they involve physical changes to the vagina. Therefore, they can significantly impact women’s quality of life, and especially their sex lives.

How to deal with vaginal dryness

Ironically, one way to manage vaginal dryness is to have more sex. Regular sexual intercourse or vaginal stimulation can help keep vaginal tissues healthy. However, if sex is uncomfortable or painful, you’ll want to find ways to remedy this problem. Here are a few tips:

• Try natural oils, including coconut, olive, jojoba, vitamin E, or avocado oil to moisturize during sexual activity or while using a vaginal dilator
• The herb kudu in supplement form has been shown to reduce vaginal dryness and restore the health of the vaginal tissue. A study of 71 healthy postmenopausal women, who used the supplement daily for 24 weeks found it helpful.
• Vaginal dilators are tube-shaped devices that help stretch the vagina and increase lubrication. They can be used with natural plant lubricants.
• Probiotics may provide some relief. In a recent study, the use of Lactobacilli L. casei rhamnosus Doderleini in women with vaginal atrophy and chronic recurrent bacterial cystitis experienced a reduction in the severity of vaginal dryness and burning as well as painful sexual intercourse. Beneficial bacteria can help restore pH balance to the vagina, which in turn can increase vaginal tissue moisture.
• Avoid the use of scented urinary incontinence pads and wear only cotton panties.

Bottom line

Most postmenopausal women can get some relief from vaginal dryness and associated symptoms by using natural remedies. If you don’t experience any relief after trying natural approaches, visit your physician for an examination. Your symptoms may be caused by another condition, as noted above.