The Sore Dry Vagina Chronicles 1- Valentine's Day Edition

Right and on we march to my next post- a subject barely talked about - the vagina (well barely talked about in this context- cant speak for banter down the local pub !!) 

Today, on this cheeky Valentine’s Day, let’s have a candid chat about the gradual (or sudden) onset of menopausal including that pesky GSM (Genitourinary Syndrome of Menopause) – and the treatments available here in the UK. 

As it is "that day" where you are either loved up or feeling a bit lonely- let me cheer you up with some all round vagina talk!! (er...yeah not sure that came out right....er a poor choice of words too...er.. I think I may stop now!!)

The Slow March of Menopause

Phase 1: The Sneaky Prelude (Perimenopause)

Before menopause makes its grand entrance, it tiptoes in with perimenopause. This stage is like a long, unpredictable trailer before the main event. In later posts I will drill down on what this exactly is, how long it lasts, why it can be so hard to recognise (it took me 4 years and I'm  a specialist).

In essence you might notice:

• Irregular periods: They can be as unpredictable as British weather.
• Mood swings: One moment you’re laughing, the next you’re crying – it’s like living in a soap opera.
• Good days or bad days- one day you just don't feel right, others "completely back to normal". There is a good physiological reason for this but, quite frankly, we all have good days and bad days so how on earth can you tell the difference?
• Early signs of GSM: Vaginal dryness might start to make its presence felt, accompanied by a slight irritation or discomfort. Maybe not even as far as dryness but a sort of burn , or you may notice it only when you sit for too long.

These early symptoms are your body’s way of signalling that changes are on the horizon. Research from sources like the British Menopause Society tells us that this period can last several years, setting the stage for the full menopausal transition .

Phase 2: Menopause – The Main Act

Once you hit menopause, defined by 12 consecutive months without a period, the symptoms can intensify. Here’s what often happens:

• Hot Flushes & Night Sweats: Imagine your internal thermostat going haywire. One minute you’re cool as a cucumber, the next you’re feeling like you’re in a summer heatwave.
• Other symptoms : mood changes, dry skin, sleeplessness, fatigue, anxiety, even increasing migraines, joint aches.
• GSM in Full Swing: GSM – a catch-all term for vaginal dryness, irritation, and sometimes discomfort during intimacy – might become more pronounced. It can make Valentine’s Day feel a bit less like a rom-com and more like a scene from a medical drama.

These symptoms can continue to evolve, and while they can be challenging, they’re also manageable. The key is understanding that menopause is a gradual process, not an overnight transformation.

What’s Happening Inside?

Our bodies are incredible machines. During menopause, the ovaries gradually produce less oestrogen, a hormone that plays a critical role in keeping tissues, including the vaginal lining, healthy and well-lubricated.

As oestrogen levels dip, the vaginal walls can become thinner and less elastic, leading to the dryness and discomfort associated with GSM. 

Think of it as a once lush, well-watered garden that, without enough rain, starts to look a bit parched. But worry not – even the driest garden can be revived with a little TLC!

Treatments in the UK: A Gardener’s Toolkit for GSM

Thankfully, there’s a robust range of treatments available right here in the UK to help rejuvenate your internal garden:

1. Local Oestrogen Therapy

• What It Does: Delivers oestrogen directly to the vaginal tissues.
• Benefits: Helps restore thickness and elasticity, reducing dryness and discomfort.
• How It’s Used: Available in creams, tablets, or rings – it’s a targeted approach that minimises systemic effects.
• Evidence: Supported by guidelines from the British Menopause Society and NICE, local oestrogen is a tried and tested option for GSM .

2. Non-Hormonal Moisturisers and Lubricants

• What They Do: Provide immediate relief from dryness.
• Benefits: Ideal for those who prefer to avoid hormones, they’re available over the counter and can be used as needed.

•  Think of them as the quick-fix water guns for your internal garden – not as fancy as a sprinkler system, but they do the job when things get a bit too dry.

3. Other treatments

• Tablets such as Ospemifeme (for some women)
• Vaginal pessaries such as DHEA
• Laser treatments

3. Lifestyle Adjustments

• What They Do: Regular exercise, a balanced diet, and stress management can all help alleviate symptoms
• Benefits: A holistic approach that benfits overall health, not just menopausal symptoms

• Consider it like tuning up your car – sometimes a bit of extra care under the bonnet can prevent bigger breakdowns later on.

4. Emerging Treatments and Innovations

• What’s New: There are ongoing developments in treatment options, including novel therapies that target GSM more precisely.

• Just as AI is revolutionising our everyday lives, innovative treatments are quietly working behind the scenes to ensure that your love life remains as vibrant as ever

A Valentine’s Day Pep Talk

So, this Valentine’s Day, if you’re finding that your body’s transitions are feeling more like a slow-motion parade than a smooth waltz, remember: you’re not alone, and help is at hand.

Menopause might bring its fair share of challenges, but with the right treatments and a dash of humour, it can be managed gracefully. Embrace the changes, chat with your GP  about the best options for you, and know that a little lube or cream can often turn a potentially arid situation into a blooming success.

Here’s to love, laughter, and keeping your inner garden well-watered – no matter what stage of the menopausal journey you’re on. Happy Valentine’s Day!

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Dr Sarah Thomas, Advanced Menopause Specialist and proud advocate of a life that’s as vibrant as it is real.