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Vaginal moisturisers after menopause

Vaginal moisturisers..versus personal lubicants…what are they? when do they help?

You will see there is a recent blog about personal lubricants. These are simple products for men and women of any stage of sexual life when more lubrication is needed to facilitate sexual activity. They might be used for sexual activity between men and women, women with women or men with men.

Vaginal moisturisers

Vaginal moisturisers are different. These are products designed very much with women in mind for those stages of life when the body’s natural vaginal lubricant, produced with sexual arousal, is deficient. After menopause, the lack of oestrogen in the body can lead to “Vulvovaginal Atrophy”. This means that the lining of the vagina is thinner and dryer. It is no longer lined with cushions of thick, secretion producing cells. There is another term that you might hear used by Doctors: “Genitourinary Syndrome of Menopause”. This is another term referring to the phenomenon of decreased lubrication and comfort at the vagina. Some women notice also increased incontinence and increased tendency to urinary tract infection, so sometimes oestrogen therapy is prescribed for these conditions.

So traditionally this discomfort occurs post menopause when we no longer have abundant reproductive oestrogen known as oestradial in our body. However, we mentioned in the previous blog, that women who are breastfeeding may also experience lack of natural lubricant due to altered oestrogen levels in the body whilst breast feeding.

It is also important to point out that some women are put into early menopause during treatment for cancer. This could be ovarian cancer, or other gynaecology cancers where the ovaries and reproductive organs are removed. Treatment for breast cancer often requires women to be put on oestrogen depletion medication. This is because some cancers are fed by oestrogen: oestrogen makes some cancers grow. By taking away all the oestrogen in the body, the cancer is robbed of the hormone that was encouraging the cancer to grow.

The treatment for breast cancer is life saving, but the effect of oestrogen depletion can have a very negative effect on quality of life cause discomfort and change to sexual comfort and well-being.

So vaginal moisturisers are products that aim to reproduce vaginal moisture leading to increased vaginal comfort and sexual comfort.

What is a vaginal moisturising product made of?

Vaginal moisturising products contain substances which are absorbed into the skin to rehydrate the skin and stick to the lining of the vagina. For example you might see the product “hyaluronic acid”. This helps keep moisture in the skin and is used also in face creams to prevent wrinkles! The products in the moisturiser mimic the natural moisture of the vagina. Unlike lubricants, which are used for immediate lubrication in the moment, moisturisers are applied once a day to every 2 to 3 days. The effect of the application might last several days unlike a lubricant. They work by increasing fluid content in the wall of the vagina and lowering the pH level (where the pH goes up without natural oestrogen). They can help ease. discomfort during sexual activity. They will also help ease vaginal discomfort in those women who are not sexually active, but experience vaginal discomfort just due to the effect of low oestrogen. (this information is taken from an article by D.Edwards and N.Panay in 2016 article published in “Climacteric” journal).

What about vaginal oestrogen?

Vaginal oestrogen is prescribed to many women who are experiencing vaginal discomfort and dryness related to menopause but not due to Cancer. It is considered safe to use and currently there is a low dose option in “Vagifem Low”. It is usually applied every day for 2 weeks then twice per week thereafter. It can be a wonderful option for many women. Unfortunately, the medication information sheet included is actually the information given for ORAL hormone replacement which is absorbed into the body so does carry some risks. So don’t let this put you off gaining the benefits of oestrogen therapy. It is known that vaginal oestrogen, in the absence of breast cancer, is safe. BUT, if you have concerns, this article is here to help you know what else is out there….

What about oils to moisturise the vagina?

Olive oil has been studied as a natural product which can help to moisturise the vagina. It has been studied in conjunction with moisturisers. Other natural oils such as coconut oil are mentioned as an option for the vagina. But looking at the studies, it is difficult to find quality studies to say how often or how to apply the oils. The oil can be applied daily massaging into the vaginal entrance just like you might moisturise other parts of the body. Its certainly worth trying if you have the problem and are averse to oestrogen products. But really, its a question of give it a go and see how it works for you….There is nothing to say that it is harmful for the vagina.

What about DHEA?

DHEA (dehydroepiandrosterone) is produced by the adrenal glands located just above the kidneys, and is referred to widely as ‘the mother of hormones’ because it is utilised by the body to produce many other hormones, including testosterone and oestrogen. In America, this product has been licensed for use as a vaginal moisturiser that might may be a good alternative for those that cannot use Oestrogen. At the moment, it is not available in Australia. It may become available if studies continue to show that it does not have unwanted side effects. I have recently been asked about a cream called “Julva” cream. This is an American product marketed as a “natural” moisturiser but note it does contain this product DHEA. DHEA is a precursor to other hormones so a product containing this, is not strictly a “non hormone” product.

I’ve heard of laser for the vagina..does it help?

Laser is available via some G.Ps and Gynaecologists. The laser acts by regenerating the cells of the vagina and there are some studies showing that for some women, it restores vaginal comfort and moisture.

So what product do i choose?

Once again, as with the lubricants, if looking for a moisturiser, the word moisturiser should be there on the packaging rather than just “lubricant”. You are trying to avoid parabens and excessive chemicals which might irritate the vaginal skin. It is very difficult to read a list of ingredients and know what they are apart from the listing of “paraben’ or “methylparaben” which is easy to spot so easy to steer clear of. There is a moisturiser which i had thought was acceptable called “replens”, but this product does contain parabens so other options might be better. I think the main advice is to be alert, read the ingredients, ask the Pharmacist what all the ingredients are and make your decision. If for any reason discomfort occurs, stop using that product. It may take a while to find one that suits you.

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