A Deep Dive Into Vulvovaginal Health During Menopause
This year, I had the privilege of sitting down with Selene Yeager from Feisty Menopause to discuss vulvovaginal health—a topic that resonates with countless women navigating the menopause journey. During our conversation, we explored exercise-related challenges that can impact vulvovaginal tissues during menopause and beyond. From discomfort during cycling to maintaining tissue resilience, we covered strategies to manage and prevent issues. Listen to the episode here.
One of the most pressing concerns we addressed was genitourinary syndrome of menopause (GSM). Affecting up to 90% of women in menopause, GSM encompasses a range of symptoms including vaginal dryness, thinning, irritation, and pain—symptoms that often persist and intensify with age due to the lasting physical changes in these tissues.
Why GSM Happens
The decline in estrogen levels during menopause is at the core of these changes. Estrogen plays a critical role in:
Maintaining pelvic blood flow.
Ensuring vaginal tissue thickness, elasticity, and moisture.
Supporting vulvar tissue resilience.
When estrogen levels drop, these tissues become thinner, less elastic, and more prone to damage. This can lead to discomfort in daily activities, painful intercourse, and urinary challenges like incontinence or recurrent urinary tract infections (UTIs).
The Good News: GSM is Treatable
Early intervention is key to achieving the best outcomes. The following treatments and strategies are highly effective:
Hormonal Treatments
Local Vaginal Estrogen
Available as inserts, creams, tablets, or rings, local estrogen therapy enhances tissue quality, lubrication, and pH balance. It also reduces UTI risk without increasing systemic estrogen levels.
Typical use: 2-3 times per week.
Intrarosa (Prasterone)
A DHEA-based option that supports tissue health for those who cannot or prefer not to use estrogen.
Osphena (Ospemifene)
A SERM taken as a daily pill, it selectively activates estrogen receptors in vaginal tissues.
Non-Hormonal Options
Hyaluronic Acid-Based Products
Products like Reveree have been shown to effectively relieve dryness and irritation.
Usage: 2-3 times per week.
Bezwecken Hydrating Suppositories
Can contain small amounts of estriol and/or DHEA for added relief.
New Developments in Treatments
Limited research supports the use of fractional CO2 lasers and radiofrequency devices for tissue rejuvenation. These are non-hormonal, minimally invasive procedures designed to improve tissue elasticity and hydration. While not universally recommended because of lack of convincing evidence, they may benefit women unresponsive to other treatments. These treatments are expensive and need to be repeated.
Exercise-Related Challenges
For active women, especially cyclists, vulvovaginal health requires special attention:
Invest in padded shorts and ensure your bike seat is ergonomically designed.
Avoid shaving or trimming pubic hair excessively; it provides natural protection against friction.
Consider using barrier creams or moisturizers before long rides.
General Care Tips
Stick to gentle hygiene practices: Avoid harsh soaps, douches, and perfumes. Opt for hypoallergenic, fragrance-free products.
Stay hydrated and prioritize regular sexual activity (either partnered or solo), as it promotes blood flow and tissue health.
When to See a Doctor
Before starting any treatment, it’s essential to rule out other conditions, such as infections, lichen sclerosis, or even cancer. A healthcare provider can provide a definitive diagnosis and personalized recommendations. By addressing GSM early and with the right interventions, women can maintain their vulvovaginal health, ensuring comfort and quality of life throughout menopause and beyond.
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