Vaginal symptoms in menopause – either natural menopause or induced menopause by cancer treatments – is one of the most common reasons women seek medical advice. It is also common for women not to mention these symptoms due to embarrassment or discomfort. Medical practitioners often forget to inquire about vaginal health, and thus it is an important issue to which to draw attention.
Vaginal symptoms in menopause are due to atrophic vaginitis. This is a term referring to symptoms of vaginal dryness, pain or burning with intercourse, itching, strong odour, and recurrent vaginal infections or urinary tract infections. The symptoms are due to thinning of the layers of cells in the vaginal canal as a result of decreased estrogen. Estrogen helps our tissue to stay healthy, so when our hormones decrease due to age or anti-estrogen cancer treatments, the vaginal tissue becomes very susceptible to irritation and infection. Estrogen also helps our bladder to stay healthy, which is the reason many post-menopausal women experience frequent urinary tract infections.
There are lots of naturopathic options that not only help to alleviate symptoms, but also to repair the tissue of the vaginal wall, to prevent symptoms from coming back. Let’s review the research below, and as always, the following information is not meant to be medical advice. Always ask an experienced naturopathic doctor if any of the below treatments can be helpful for you.
1. Local Hormone Therapy
There is strong positive evidence for the use of vaginal estrogen therapy for the treatment of atrophic vaginitis in menopause, and the practice is supported by the North American Menopause Society. Vaginal estrogen suppositories are extremely effective at preventing the symptoms of vaginitis. However, if a woman has a history of hormone sensitive breast cancer, this topic is much more controversial. While several large studies have shown that vaginal estrogen therapy did not increase the risk of a breast cancer recurrence, caution and strict monitoring is still required. Other hormones that can be used vaginally are DHEA, estriol (a less potent form of estrogen) and testosterone, which may be safer for women with a history of breast cancer. Speak to an experienced doctor or nurse practitioner about vaginal hormone therapy to see if you are a candidate.
Internal laser treatments have recently been marketed to treat atrophic vaginitis in menopause, but they may not be right for all women. Another option is a new, Health Canada approved treatment called Femme 360. It is a safe, non-hormonal treatment that uses radio frequency instead of more abrasive laser therapies. It increases vaginal collagen and elastin to improve vaginal tone, relieve urinary leakage, improve vaginal dryness and relieve vaginal pain with intercourse. And, as a “side effect”, it has been shown to improve sexual response (i.e. improve orgasm response) in women. Not bad for a side effect! A fabulous nurse practitioner in Calgary that offers this treatment is Jeannette Queen at EvolveWell clinic. She has extensive experience in women’s health, and I highly recommend her services.
3. Hyaluronic Acid
Hyaluronic acid is a fabulous molecule. It is a local treatment, and once absorbed into vaginal tissue it improves collagen and elastin. It can also hold 1000 times its weight in water molecules, which creates a plumping effect to tissue. One recent study looked at how effective a hyaluronic acid cream was for treating vaginal symptoms, and the results showed that itching, pain during intercourse, urinary incontinence, vaginal dryness and pH were all significantly improved. What is even more impressive is that these symptoms improved more in women who used hyaluronic acid compared to those who used vaginal estrogen.[Int J Community Based Nurs Midwifery. 2016 Jan; 4(1): 69–78.]
During the premenopausal years, estrogen promotes healthy Lactobacillus species to flourish in the vagina, which then creates lactic acid. This lactic acid maintains a crucial pH to the vagina that prevents any kind of overgrowth of pathogenic bacteria. Therefore, when estrogen decreases, our healthy bacterial environment gets disrupted and infections can easily occur. It has been demonstrated that taking oral probiotics can increase the numbers of healthy bacteria in the vagina. One study showed the probiotics rich in Lactobacillus species effectively treated bacterial vaginosis and candida infections associated with menopause.[J Menopausal Med. 2017 Dec; 23(3): 139–145.]
5. Vitamin D Suppositories
You are probably familiar with taking vitamin D supplements orally, but did you know you can get vitamin D suppositories specially compounded? Vitamin D is directly responsible for helping new, healthy cells to grow in the vagina. If you remember from the beginning of this blog post, atrophic vaginitis is caused by thinning layers of cells, but vitamin D actually encourages new cell growth, to keep the vaginal canal looking like new! Vitamin D has been shown to improve the pH of the vagina, decrease pain with intercourse, and improve dryness. [Iran J Nurs Midwifery Res. 2015 Mar-Apr; 20(2): 211–215] An improved pH improves the bacterial environment of the vagina, and decreases infections as well.
6. Supplements for Urinary Tract Infections
The standard of care for urinary tract infections is antibiotics. However, if a menopausal woman is also suffering from vaginal infections, antibiotics is the last thing she needs. Curcumin and quercitin are safe and well tolerated supplements that have been shown to reduce the frequency of urinary tract infections. When taken for this purpose, they have also been shown to reduce pelvic pain and improve sexual function.[Female Pelvic Med Reconstr Surg. 2018] In women with a history of breast cancer, curcumin and quercitin have also been shown to have potential anti-cancer activity, and therefore these supplements could have a beneficial dual purpose.
There are in fact numerous other interventions that I could review in this blog post, which include different oils (olive oil, coconut oil), herbs (calendula, garlic) and even vaginal exercises. If you are suffering from uncomfortable vaginal symptoms, know there are many natural, safe and effective solutions that can help you. Call me to discuss any of your women’s health needs.