If you first notice this symptom when you enter perimenopause or menopause, it can feel like a bad metaphor for life – everything, including your sex life, is drying up. Rest assured, this is not the case. Your vagina, like you, is very resilient. Relief can be found – without the excessive addition of supplemental estrogen into your system. Let’s learn how to treat vaginal dryness naturally.
Understanding a Healthy Vagina
To know when something has gone awry, it’s important to know what is healthy and what could be a sign of an issue. Both moisture and a reasonable amount of vaginal discharge are normal in a healthy vagina. This discharge will change naturally with hormonal cycles and as you age, but typically it will be a clear to slightly white fluid, with a pasty or slippery texture and no odor. Around ovulation, this fluid will include a stringy discharge from the cervix, that looks much like egg whites. This is called fertile mucus. When you are sexually aroused, you will usually see slipper, clear discharge from the skenes glands, which are located on either side of your vulva.
Estrogen and progesterone are essential to your body in providing adequate lubrication for your vagina. Hormones shift in perimenopause and menopause, and it’s common for some women to experience dryness as these secretions diminish. It’s also common for women in any stage of their lives to experience vaginal dryness, for a variety of reasons. But for now, let’s focus now on what happens when your hormones aren’t balanced – and what you can do about it.
The Connection Between Vaginal Dryness and Hormonal Imbalance
There are many reasons your hormones can be thrown off course. The most common is what we’re talking about here: perimenopause and menopause. If you’ve had a hysterectomy, the imbalance can be even more serious. Your body begins to shift its hormone production naturally as it prepares to stop the ovulation cycle, and these shifts are quite dependent on lifestyle choices, diet, and your genetics.
Progesterone levels tend to decrease first, which sometimes means a woman has too much estrogen relative to the progesterone levels. This may need to be balanced with progesterone supplementation if severe enough. Other women may have a drop in both hormone levels. A drop in estrogen is likely to cause vaginal dryness because one of its jobs is to keep the vagina lubricated.
Treat Vaginal Dryness: A Natural Approach to Relief
When vaginal dryness occurs in menopause, you may well need the support of some form of supplemental hormone. But that doesn’t mean you can’t support your body and treat vaginal dryness naturally. Try the following suggestions before – or in conjunction with – using hormonal support.
Hydrate!
It’s seems so simple, but most women I talk with tell me that drinking enough water is sometimes difficult. And if your body is constantly dehydrated, you won’t find it easy to remain lubricated. Alcohol and caffeine contribute to dehydration, so be aware of how much you are consuming, and keep a bottle of filtered water handy at all times!
Know What’s in Your Hygiene Products
Douches and perfumed hygiene sprays are never a good idea. It’s also wise to avoid drying soaps and bubble baths. Instead, choose pH balanced soap that is free from antibiotics and chemical deodorants.
Eat Well
A balanced diet that includes enough healthy fat will help your body produce as much estrogen as possible. Pay attention to how much sugar you’re eating – it has huge impacts on your body’s natural balance. Examining food sensitivities can also be useful. Eating whole soy products can boost your hormones enough to relieve vaginal dryness, as can other foods high in phytoestrogens, such as nuts, flaxseed, apples, celery, cherries and more.
Boost Wellness with Nutrients and Phytotherapy
A high-grade supplement can make all the difference; your body can’t perform its essential duties without the right nutrients. Plants are powerful medicine, and many have phytoestrogens that have been proven to help with dryness, including black cohosh, red clover, and kudzu.
Remember, your body is unique, and it may take some time to find the right solution for you. And with natural support you just might find that you don’t have to depend of prescriptions as long as you might otherwise.
Non-Hormonal Products for Vaginal Dryness
Before you turn to products filled with hormones, consider some of the non-hormonal products available to help treat vaginal dryness. Non-prescription products for vaginal dryness can be used as needed, in-between or in addition to the prescription bioidentical estrogen.
Always be sure to read the labels on the products you are considering using and choose those that contain no harsh chemical ingredients, preservatives, petro chemicals, endocrine disruptors or other irritants. It’s best to avoid alcohol, parabens and propylene glycol. In the chart below we’ve listed a few products which have been used by many women and often have great results.
| Over the Counter Products to Treat Vaginal Dryness | |
|---|---|
| Vitamin E Vaginal Suppositories | These can be an excellent choice for women who are not using prescription products, or for nights when you don’t use your vaginal estrogen product. Be sure to choose a naturally sourced vitamin E product. |
| Natural Oils | Grapeseed, olive, sweet almond, sunflower, or coconut are great natural oils that are gentle. Use during or after bathing, or even during sexual intercourse. |
| Sylk | Sylk is a natural personal lubricant. Made from the kiwifruit vine, this is a wonderful alternative, preferred by many women. Sylk contains no parabens or propylene glycol. It tends to be less sticky than other lubricants. |
| Astroglide | Astroglide is a paraben-free, glycerin-free lubricant beneficial for providing more lubrication when the area is drier and more friction is experienced. Discomfort during intercourse can be relieved as friction is decreased with this lubricant. |
Prescription Solutions
Sadly, conventional practitioners often immediately go to a prescription for Premarin Vaginal Cream to treat vaginal dryness. This product contains estrogens from female horses – totally unnatural to our bodies, and often much too strong.
It’s important to know that’s not your only option! There are several safe and effective bioidentical choices to treat vaginal dryness. The greatest news of all is that these creams are just as effective – in fact, probably more so.
Locally applied bioidentical estrogens are considered a much safer option than oral hormone therapy since most of them allow only minimal amounts of estrogen to enter into your circulation. The three key estrogens are estrone (E1), estradiol (E2), and estriol (E3). Presently pharmaceutical companies produce estradiol-based bioidentical vaginal products.
I encourage you to be evaluated by your gynecologist to make sure there is no underlying cause for your vaginal dryness; and it’s important to follow up to make sure your condition improves. Once you’ve ruled out larger issues, there are some great options to try. You should have as much information as possible so that you know which treatment to request; I’ve outlined pertinent information in the chart below.
| PRESCRIPTION ESTROGEN PRODUCTS* to Treat VAGINAL DRYNESS | |
|---|---|
| Estriol Vaginal Cream | |
| Contents | Women to Women Healthcare Center patients are prescribed estriol vaginal cream as a first stage of intervention. It is formulated in a pH-balanced base in concentrations of 0.6 mg/g or 0.8 mg/g. Sometimes the dose is higher if the atrophy is severe. |
| Typical Use | One gram is inserted vaginally at bedtime every night for 7-10 nights, then 2-3 times weekly. A small amount of the cream can be applied to the vulva and external areas of the vagina as needed. |
| Pros | Estriol vaginal cream is a great option to treat vaginal dryness, because it is so gentle and safe to use, especially if there are concerns related to breast cancer. Many of the local oncologists are now using estriol for women who have breast cancer, or a history of the disease.
This type of cream will slowly but effectively help both internal and external vaginal tissue, and can also be used on the vulva and urethral tissue. Results may be expected in as little as 1-2 weeks. Estriol vaginal cream can also be custom-compounded to include a small amount of testosterone and DHEA. This is especially beneficial for many women as it quickly plumps up the tissue and can also increase sex drive. |
| Cons | Some women report that the cream feels messy. This method is only effective when used as recommended. It is not intended for use as a personal lubricant for sexual intercourse. The best time to use this is at night before bed. Some women also have some burning when they first introduce the cream, but changing the base can alleviate this symptom. |
| Availability | Estriol vaginal cream is available only by prescription from your provider. Many compounding pharmacies are able to formulate this and it is almost always very affordable. Many insurance companies do not pay for this product. |
| Vagifem Vaginal Inserts | |
| Contents | The Vagifem estradiol vaginal tablets are little, white suppositories containing 10.3 mcg of 17ß-estradiol hemihydrate, which is equivalent to 10 mcg of estradiol. They come in boxes of 8 or They come in boxes of 8 or 18 tabs. Each box comes with an applicator. |
| Typical Use | One suppository is used vaginally at bedtime anywhere from 7–14 nights, and then reduced to one insert two to three nights per week for maintenance. |
| Pros | These inserts are not messy, they are easy to use, and are very effective for renewing the vaginal tissues. With a little time, the vulva also usually responds. |
| Cons | Vagifem usually does not work as quickly as creams do on the external tissues. You must use it regularly to maintain results. For women with severe atrophy, a cream may be necessary initially and then the suppositories can be used. It is not intended for use as a lubricant prior to sexual intercourse. |
| Availability | This brand name product is available by prescription through regular pharmacies. |
| Estrace Vaginal Cream | |
| Contents | Estradiol vaginal cream, USP, 0.01% |
| Typical Use | One gram is applied vaginally at bedtime for approximately 7-10 nights, and then should be reduced to 1–3 times per week for long-term care. Massaging small amounts to the vulva and inner labia can also be very helpful. This recommendation is seldom mentioned on the insert directions. |
| Pros | Results are often noted in 1–2 weeks, but it may take longer for optimal results. Using this product can be very helpful for those with extreme atrophy prior to using the Vagifem or 90 day ring products. |
| Cons | Women often complain that it can feel messy, especially during the first few days of use. You should keep in mind that you need to keep with the routine to maintain results. It shouldn’t be used prior to sex because it is a hormone. A burning sensation has been reported; you may want to consider duplicating the cream with a compounding pharmacy in a more hypoallergenic, pH-balanced base to help with the comfort. |
| Availability | This brand name product is available by prescription through regular pharmacies. |
| Estring 90-day Vaginal Ring | |
| Contents | Estring (estradiol vaginal ring) is a silicone-based ring containing 2 mg estradiol. Estring releases estradiol (approximately 7.5 mcg/24 hours) in a consistent stable manner over 90 days. |
| Typical Use | One ring is inserted into the vagina and stays in place for 90 days. After 90 days, it is replaced with new ring. |
| Pros | This delivers a low dose of estradiol for 90 days of use with no modifications needed. It can help to provide support to the walls of the vagina in women whose pelvic floor muscles are weak or have weakened. |
| Cons | This device requires some amount of skill to insert and take out. Certain women have had discomfort with the insertion and removal process and opt to have their practitioner do it for them every 90 days. Many women find an Estring comfortable. The use of Estrace vaginal cream for one month prior to initial insertion of an Estring can greatly improve the comfort level. Some women complain of breast tenderness with the estring. If this happens you may be getting too much estrogen that is actually getting systemically absorbed. This product has also been known to exacerbate endometriosis if it is present. |
| Availability | This brand name product is available by prescription through regular pharmacies. |
| Femring 90-day Vaginal Ring | |
| Contents | Femring (estradiol acetate) is a flexible silicone-based ring which contains time-released estradiol acetate. It is available in two strengths: 0.05 mg/day and 0.10 mg/day. The 0.10 mg/day usually requires special ordering. Both strengths issue estradiol acetate daily for 3 months and supply system-wide, not just vaginal-specific, estrogen replacement therapy. This is quite different in its applicability as it is a type of Hormone Replacement Therapy which provides estrogen locally and systemically. |
| Typical Use | A ring is placed into the vagina for 90 days and then removed and replaced as needed. |
| Pros | The Femring is softer and is more flexible than the Estring, so insertion and removal is reported as easier for many women. It can help to support the walls of the vagina for women whose pelvic floor muscles are weak. |
| Cons | Some women aren’t comfortable inserting and removing the device, so they may require a visit to their provider every 90 days to have it changed. This product has a potential for causing exacerbation of endometriosis discomfort in women with a history of this due to the potent delivery of estrogen directly within the pelvic area. |
| Note | The product provides estradiol vaginally, as well as systemically, similar to the estradiol patch or other forms of Hormone Replacement Therapy, to treat vasomotor (for example hot flashes) as well as vaginal symptoms. This is not just a localized vaginal treatment, but is a hormone replacement treatment for system wide therapy. If you still have your uterus, you must use a prescription-strength progesterone (bioidentical) product, like Prometrium, with this product. |
| Availability | This brand name product is available by prescription through regular pharmacies. |
| * Note: Brand name pharmaceuticals are all FDA-approved and regulated. These products are packaged with the same warnings that the FDA states must be listed on all estrogen products. There is evidence to suggest that taking low-doses of estradiol either through topical means or vaginally does not increase the risk for blood clots to the degree that taking estrogen by mouth does. However, the FDA continues to require the warning label on all estrogen products. | |
Final Thoughts on How to Treat Vaginal Dryness Naturally
I know that every woman is different and unique in her response to vaginal bioidentical estrogen and other products. Please understand that you may need to try several before your vaginal dryness resolves. Be patient with yourself, and with your body, and never give up hope.
There are always options, whether you have mild or severe, occasional or on-going vaginal dryness. Knowing your alternatives, whether improving diet and using a personal lubricant or a stronger treatment, is essential to treat vaginal dryness. If you try an option or two without relief, be persistent – you don’t have to live with vaginal dryness forever!
