Vaginal dryness, dyspareunia, irritation, burning and itching in the vaginal region are all symptoms of vulvovaginal atrophy. In menopause this is attributed to the reduction of hormones in the urogenital area.
Physiological causes
To understand what is happening down there we need to understand the role of androgens and oestrogen in supporting the urogenital area.
Androgens are generally thought of as male hormones but they perform approximately 200 roles in the female body, one of the major roles is there conversion to oestrogen. This occurs in the adrenal glands, fat cells and the ovaries. Another role of androgens is regulating nitric oxide synthase and arginase, a key protein which plays a major role with vaginal blood flow. Decreased blood flow is associated with decrease sexual pleasure. Women experience a decline in androgen receptors as they age resulting in poor vaginal lubrication, decreased or painful sensations and changes in vaginal smooth muscle structure. As a precursor to oestrogen the decrease in androgens during the menopausal years results in a decrease in oestrogen.
Oestrogen maintains the levels of collagen and elastic fibers that support the structure of the vaginal region as well as helping regulate acidic mucopolysaccharrides and hyaluronic acid which provide moisture and assist the epithelial barrier. Oestrogen prior to menopause stimulated the production of glycogen by vaginal epithelial cells, The regular shedding of these cells into the lumen resulted in the stores of glycogen being broken down into glucose which in turn is broken down into lactic acid by the most common microorganism Lactobacillus spp. which kept the vaginal pH at between 3.5-4.5. A pH of 4.6 and greater leads to a diagnoses of vulvovaginal atrophy.
What does that mean for me?
It means that you have/had a thick vaginal epithelium layer that over the course of going through menopause will thin, the amount of mucus you are making will decrease as your oestrogen and glycogen levels decrease, your level of gut microbiome will change, Lactobacillus spp. will decrease resulting in a higher diversity of microbial organisms which could result in a higher vaginal pH thus putting you at risk of experiencing the symptoms of vaginal atrophy.
Post menopausal vulvovaginal atrophy is though to affect approximately 45% of post menopausal women , with only 25% of these women seeking assistance. If your one of them don't despair there are things you can do to assist yourself including:
What do I do?
Consider dietary options, some women get benefit from a high phytoestrogenic diet, others from a Mediterranean diet, the inclusion of antioxidants may also be beneficial. Keeping within a healthy weight range to reduce inflammation and reduce toxic overload is also recommended.
Improving your gut microbiome; this can be as simple as increasing your Lactobacillus which can be done by adding yogurt to your diet.
Use a lubricant. Sexual activity has been shown to be beneficial in keeping the vaginal environment healthy. If you experience low libido there are supplements and herbs that can assist you.
Exercise- regular exercise has been shown to increase blood flow to the urogenital region keeping the region healthier.
Get your vitamin D level checked, supplement if needed, as it helps to maintain good vaginal structure and function.
Get your vaginal pH checked if you are concerned this is done by using test stripes.
Overwhelmed by the symptoms or not sure where to start on recovering with so
many different options for treating these symptoms from dietary changes, supplements, and herbal teas and tinctures. Please don't suffer any longer book an appointment today and get some relief.
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