Dr Phil: After the menopause

I thought I just had to pad up and shut up. So said a 52-year-old woman who'd finally got through the menopause and thought she could relax, only to be faced with a whole host of unpleasant symptoms down below. Vaginal dryness and soreness, painful sex, leakage of urine and recurrent urinary tract infections that didn't seem to respond to antibiotics. Trouble was, she was too embarrassed to discuss these, either with her partner or her GP, so she suffered in silence until she heard a radio broadcast about the post-menopause and realised she wasn't alone.

So what's going on here? Women (and men) have oestrogen receptors all over their bodies and after the menopause, the lack of oestrogen affects many organs. Most women are aware of the hot sweats, emotional changes and longer term risks of osteoporosis, but symptoms down below are harder to talk about. Without oestrogen, the skin and support tissues of the vulva (lips) and vagina become thin and less elastic. This makes them more easily damaged, especially during sex if lubrication is poor. Even the everyday friction of your vulva rubbing against underwear can cause discomfort. The oestrogen lack also changes the pH of the vaginal secretions, suppressing normal levels of good bacteria (e.g. lactobacilli) and leading to a watery, discoloured, slightly smelly discharge that can cause burning and irritation. Unsurprisingly, some women think they must have contracted a sexually transmitted infection.

Lack of oestrogen also makes your pelvic floor sag, and many women get some prolapse as the womb drops down against a weakened vaginal wall (usually at the front). The hood that protects the clitoris can shrink, which can leave the clitoris sore, exposed and very difficult to talk about. And then there are the urinary tract symptoms, ranging from incontinence to overactive bladder and recurrent symptoms of urinary tract infections.

So, what can be done about all this? Clearly we need to recognize and discuss symptoms openly, with friends, partners and health professionals. Soap tends to make skin dry, which is bad news for an already dry vagina, so switching to aqueous cream can make a difference. As for lubricants, the best well-known (KY Jelly) is a lot messier than Liquid Silk or Replens MD (available on prescription or over the counter).

Local oestrogen therapy can make a huge difference to vaginal dryness, soreness and urinary symptoms. It comes in the form of daily tablets, pessaries and creams, or a vaginal silica ring that can be inserted for 3 months. The good news is that the dose of oestrogen is low and the risk of side-effects associated with HRT is much smaller. Pelvic floor exercises are always worth doing, and there are even pelvic-floor physiotherapists who know all the tricks and tools to strengthen things up. Occasionally, surgery is needed for stress incontinence (the kind that makes you leak when you cough or jump), but it's much less invasive than it used to be and rarely is a hysterectomy performed.

For more information, you can surf this site or the specialist site www.menopausematters.co.uk. The bottom line, as ever, is don't be embarrassed to ask for help. There's plenty that can be done.

Interesting fact: After the menopause, women often have lower oestrogen levels than men.

Dr Phil Hammond is a medical doctor, comedian and commentator on health issues. http://drphilhammond.com

Written by: Dr Phil Hammond
Edited by: Dr Phil Hammond
Last updated: Wednesday, August 4th 2010

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Comments on this article

Posted by Optional on 10/10/2011 at 02:52

I HAVE HAD A HISTORECTOMY WHEN I WAS 28 I WENT THROUGH MENOPAUS EVERYTHING WAS FINE UP UNTILL 2 YRS AGO WHEN I GOT STRONG ERGES FOR SEX I DISCHARGE A LOT I STILL HAVE ORGASIMS AND WANT SEX BUT I TRIED THE KY JELLY BUT FIND IT IS TO THICK AND IRRITATES ME WHAT CAN I TRY TO MAKE SEX COMFORTABLE

Posted by mac on 22/09/2011 at 09:08

I have used ky jelly for years now they have changed the formula and so it burns each time we have sex is there anything else we can use also allergic to lanolain

Posted by Optional marianna on 11/05/2011 at 06:02

vagina dryness causes pain during intercourse. any suggestions for treatment? thank you

Posted by Linda A on 21/03/2011 at 05:18

Has anyone used a Vaginal Slica Ring, if so did it help, & was it easy to use?

Posted by Stormy on 03/03/2011 at 02:11

I had a complete hyst. when I was 32 yrs old. for the past 20 years my vagina has been so dry that it bleeds. the lining tissue in the walls of the vagina are so thin. Also I had my cervix removed during hyst. I take premwein .625 mlg. it keeps my vagina from bleeding, but i have to use a lubricant to have sex. and also drys out befor the at is over. I do not ever get a climax during sex. why and can you help? but without the premerin I would never be able to have sex again. also I have this real thick discharge. I use a vinegar douch about 4 times a year. the discharge has got worse the past few months. As I have had sex more in the past year than I have in about 7 years. Does this cause the thick discharge. Well actually it is not discharge it does not run or drip out. I just can get it out with my finger when I apply the lubricant befor sex.

Posted by on 04/02/2011 at 12:28

I am using Replens, although this helps a little, can you advise an alternative as I appear to be alergic to oestrogen based products.

Posted by Franka on 28/08/2010 at 02:54

Thank you for the useful information. Franka

Posted by Symptoms of Menopause on 26/08/2010 at 05:12

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