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Are your bits a bit sore?

menopause perimenopause sexhormones Apr 15, 2022

It is incredibly rare for women to tell me about vaginal dryness or problems with sexual function in a health work-through despite vaginal/vulval dryness affecting the majority of women in menopause. 70% of women are believed to experience some genito-urinary problems in meno but unfortunately only a small number discuss it with their GP.

What women are happier talking about is their increased need to wee; multiple trips to the toilet during the night; & recurrent UTIs. These can all be part & parcel of the same underlying issue – low levels of oestrogen. There are oestrogen receptors in the vagina, urethra, bladder & pelvic floor, and they may all be affected during peri/meno and beyond.

The tissues start to thin. We lose the cells that line the surface of the vagina, urethra etc. We also lose collagen & elastin and hence tissue fullness, elasticity & strength.

Signs & symptoms include vaginal & vulval dryness & atrophy, pain during intercourse, possible bleeding after sex, increased trips to the loo both day & night, increased infections, weakening of the pelvic floor. Unfortunately, this also appears to be one of those symptoms that very often doesn’t improve once we are post-menopause.

So what to do?

There is some evidence around Sea Buckthorn helping with tissue restoration & improved lubrication. It can be taken both orally as a capsule or oil or topically as a gel.

I haven’t personally tried a brand called OlioVita, but they do look interesting & I may be tempted to do a trial for the overall tissue support.

The evidence is weaker around soy isoflavones.

Lubes & moisturisers like YES, Sylk & Regelle are available both on prescription and over the counter. Moisturisers have an ongoing effect – typically up to 3 days. Lubricants are typically used during sex.

The fastest resolution is via topical oestrogen, either in pessary, cream or gel form. This doesn’t enter general circulation but reverses the localised atrophy & restores function. I am comfortable advising that this is the route I have taken myself and it has worked brilliantly.

Pelvic floor work, I think, should be followed regardless. I am ‘lifting’ as I write this! Speak to a yoga therapist, women’s health physio or other pelvic floor expert.

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