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Vulvovaginal Health & Comfort for Life

I recently had to opportunity to sit down with Selene Yeager from Feisty Menopause to talk about vulvovaginal health during menopause. We discussed several exercise-related issues that can show up during and beyond the menopause transition that can cause pain, discomfort, and even damage to your vulva and vaginal tissues. Listen here.


Menopause introduces a host of changes, and among them, the genitourinary syndrome of menopause (GSM), which emerges as one of the most prevalent and troublesome issues, affecting up to 90 percent of women according to various studies. Unlike some symptoms that may diminish with time, GSM symptoms such as vaginal dryness, thinning, pain, and irritation tend to persist and even worsen as we age due to the physical alterations in the tissues.


The decline in estrogen levels during menopause plays a pivotal role in these transformations. Estrogen is essential for maintaining pelvic blood flow, vaginal tissue thickness, elasticity, and moisture, as well as the resilience of vulvar tissues. Without an adequate supply of estrogen, the tissues become thinner, drier, less elastic, and more susceptible to damage, resulting in discomfort during daily activities and sexual intercourse. Furthermore, estrogen deficiency can contribute to urinary issues like incontinence and urinary tract infections, along with other conditions.


Thankfully, the changes associated with GSM are highly treatable. Early intervention offers the most favorable outcomes; therefore, it's crucial not to wait until symptoms worsen significantly to seek help. Local hormone therapy, particularly vaginal estrogen, stands out as the most effective treatment. It enhances tissue quality, lubrication, and pH balance, while also reducing the likelihood of UTIs, without increasing systemic levels of estrogen. Non-estrogen hormonal alternatives that contain DHEA like Intrarosa (prasterone) may provide relief for those not completely helped by estrogen therapy alone, as well as those unable or unwilling to use estrogen therapy. Local hormone therapy is available in many forms, including inserts, capsules, creams, and tablets. Most are recommended to be used 2-3 times per week.


Another option is Osphena (ospemifene), a selective estrogen-receptor modulator (SERM), which mimics estrogen effects in some tissues while inhibiting estrogen effects in others. Ospemifene works for GSM by selectively activating estrogen receptors in the vagina and is taken as a once-daily pill.


Non-hormonal products containing hyaluronic acid (HLA) offer relief from symptoms like itching, burning, and dryness and have been shown in some studies to be as effective as estrogen. Reveree is a vaginal moisturizing insert that contains HLA. It is recommended that you use it 2-3 times per week for optimal results.


I've also found that some women benefit from using Bezwecken Hydrating Suppositories, which contain small amounts of estriol and or DHEA.


It is critical that women see their doctor to get a definitive diagnosis before starting any treatment since a variety of other conditions, like yeast infections, bacterial vaginosis, trichomoniasis, lichen sclerosis, lichen planus, inflammation secondary to an irritant, gonorrhea, chlamydia, urinary tract infections, or cancer.


Due to the damaged tissues caused by menopause, maintaining gentle hygiene practices is important. Women should avoid harsh cleansers and douches in favor of basic hygiene using hypoallergenic soap and water. Avoid perfumes.


Active menopausal women who are cyclists can take steps to minimize discomfort by wearing comfortable padded shorts and ensuring proper bike seat ergonomics to prevent exacerbating symptoms. Women should consider not trimming their pubic hair, as it provides some protection against friction, particularly helpful for cyclists.


By addressing GSM symptoms through appropriate interventions, women can maintain their vulvovaginal tissue integrity, contributing to their comfort and overall well-being throughout menopause and beyond.



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