Read the full video transcript below
Hello and welcome to my weekly video blog, and today on A.Vogel Talks Menopause I'm going to talk about six of the most common issues that you can experience with the vagina in the peri-menopause and in the menopause itself.
Do you really know anything about your vagina?
But first of all, I need to ask you a question. Do you really know anything about your vagina at all? Do you know how it behaves, do you know what kind of environment it has and probably most of you will go, "Hmm, not really." So I thought that I would just talk a little bit about the vagina itself first because once you understand it then you will have a much clearer idea of the sorts of things that can go wrong and also how you can put them right just with some little bit of self help.
So at rest, the vagina is normally 2 to 4 inches long and the sides actually just very gently touch together. During intercourse the vagina can actually stretch another couple of inches and it will actually widen out quite a bit. So the vagina, it's really a big muscular tube or canal because, you know, we do call it the birth canal, but the skin inside is very, very thin. It's also very elastic and very robust. If you imagine how quickly the vagina has to change size when you're giving birth so you can see the sort of strain and stresses that the vagina has to deal with on a regular basis. The vagina also has a very special environment.
Now, before you start the approach of the menopause, oestrogen will trigger the cervix into producing a mucus and this mucus is just very slightly acidic which is really important because that acidic mucus can help to restrain any bad bacteria or fungi that may actually inadvertently appear in the vagina.
This slightly acidic mucus also sustains a colony of friendly bacteria but the friendly bacteria in the vagina are very different to the combinations of friendly bacteria that you get in your digestive system. So this is something that's really important to keep in mind as I go through all the different symptoms.
So in the menopause, because of lowering oestrogen affecting the production of mucus in the vagina, this can have a huge impact on all areas of your vaginal health.
Symptoms of reduced mucus
Symptom 1 - Candida & thrush
So let's look at some of the symptoms that you may be experiencing. If the mucus in the vagina decreases, that means that the level of acidity decreases as well, which means that other bacteria can get in, other fungi can get in and that can give you things like thrush, it can give you things like Candida and it can give you other bacterial infections of the vagina.
What can you do?
Now, in this situation, very often you're given anti-fungal medication. The problem is here that that can affect the pH as well so you need to be really careful because if you reduce the pH any further that's going to kill off more of the friendly bacteria and you will find that you end up getting repeat infections of thrush.
In this situation a vaginal probiotic is one of the best things that you can use. Ordinary digestive probiotics will not help you. Remember the combination of bacteria in the vagina are very different so you need to get a specific vaginal probiotic. Most health food shops will stock them and you can get them there.
So, and the other thing here that's really important, if you're getting a lot of thrush, a lot of Candida, is to really cut your sugar consumption because thrush and Candida love sugar so try and keep that out of your diet while you're actually doing this kind of treatment.
Symptom 2 - Cystitis & repeat bladder infections
The second sort of symptom that you can get very regularly is cystitis and repeat bladder infections. Now you might be thinking, "Well, what has the vagina got to do with my bladder?" The two of them are very closely linked. If the level of friendly bacteria decreases in the vagina, that can have a direct effect on your bladder health and remember in the menopause your bladder tends to get weaker and more easily irritated anyway.
The friendly bacteria in your vagina police that whole particular area and the opening to the bladder which is called the urethra, it's the tube from the outside world up to the bladder, is often policed by the friendly bacteria that stay in the vagina.
So if you lose the friendly bacteria in the vagina then that will leave you more vulnerable to infections such as cystitis and the problem here is we then go and get antibiotics and antibiotics kill off more of the friendly bacteria and that's when we end up getting repeat bladder infections and that will weaken the bladder further, it will make the bladder more irritable and it just creates the most horrible uncomfortable situation.
What can you do?
In this situation, again, you would be looking at a vaginal probiotic, you'd be looking at loads of water to keep the bladder as clear as possible and you can look at cranberry products to help to treat the infection and to help as a preventative. So if you're getting repeat infections, you can use a cranberry product such as our Cranberry Complex over a few months just to keep everything really nicely under control.
Symptom 3 - Vaginal dryness
One of the major problems that we do have in the menopause is vaginal dryness and this can cause a whole raft of issues. Again, if we're reducing the production of mucus, that will affect the friendly bacteria and that will reduce the mucosity of the vagina even further.
The problem here is, now remember at the beginning I said that the vaginal...the lining of the vagina is very, very thin. So although it's strong, if that thinness and flexibility gets affected because there is very little mucus, then the inside walls of the vagina they can become very brittle and they lose their elasticity and that can cause a lot of problems. Just in moving generally, a lot of women find if they get vaginal dryness it can be really uncomfortable just walking, sitting down, standing up and doing sports is usually out of the question.
It can have a huge impact on your sex life as well because not only is there the dryness but if the vagina itself is really sore, if it's not flexible any more, it can cause a great deal of pain. And a lot of women find after intercourse that sometimes there's a little bit of bleeding or spotting and very often that is because the lining of the vagina has actually been torn or irritated or scraped during intercourse. So if you're getting this spotting on a regular basis after intercourse, you know, that's a good indication that there might be too much dryness going on here.
Also in this situation, the minute the vagina starts to dry out, you can get irritation. So you can get a lot of itchiness, you can get a lot of inflammation and that can lead to more discomfort so you can almost end up with a vicious circle going on in this situation and it's very difficult to put right.
One of the only things you will be likely to be offered if you go and see the doctor is a vaginal pessary which is usually oestrogen-based which for some women is enough to help them but obviously there's a load of women that don't want to go so far down this route.
What can you do?
So what can you do in this situation? So first of all we are looking at obviously the vaginal probiotic, remember the water. You can look at some kind of phytoestrogen to help to raise your oestrogen levels up, so that would be things maybe like black cohosh or our Menopause Support if they're appropriate.
If you're getting a lot of itching and inflammation, then there is a product you can get called Aloe Vera gel. What you can do is you can put it in the fridge, it's very cooling, it's very soothing but make sure that it is additive-free, get a really pure one because the last thing you want to be doing here is putting loads of chemicals on an area that's already very sore and very inflamed.
Symptom 4 - Thin skin
For some women the skin can get so thin on the vagina and also the vulva area that you end up with nerve pain and this can be really difficult to sort.
What can you do?
You could try very gently applying, maybe two to three times a day, something called St. John's Wort Oil. This is wonderful for nerve pain and it's also very soothing but you need to just apply it very, very sparingly.
Symptom 5 - Change of smell
You will for some women find that the mucus, there's a change of smell. Sometimes you think that you're smelling really strongly and other women find that, you know, it upsets them so much that they end up showering three or four times a day.
What can you do?
Very often this is just due to a change in the levels of the bacteria in the vagina and this one can usually be put right quite quickly by using a probiotic.
The other thing you can do here is, well first of all, please don't use any of the vaginal deodorants that you get. Most of them will contain chemicals, they will possibly affect the friendly bacteria even more. But what can be really helpful is to go for a very pure Crystal Rock deodorant spray with no additives in it. These are usually gentle enough for a very sensitive area, they won't interfere with your friendly bacteria but sometimes they can help to get rid of the not so helpful ones.
Change of smell often goes with a change of the mucus itself. You might find that your vaginal mucus or discharge gets more sticky, it might get more runny, it might change colour. This tends to be due to the hormones and this is very common when you get to the peri-menopause where your oestrogen and progesterone levels are still in a bit of a cycle.
If your oestrogen is starting to go really high, and remember oestrogen triggers the cervix to produce mucus, then the cervix can be over-stimulated and you can end up producing a lot of mucus and some women say it can be really horrible, it's almost like having a non-blood period, and very often that's just due to the fact that your oestrogen is running a little bit out of control.
Agnus castus and probiotics
There is a possibility that the herb agnus castus may help here but you need to look at what's happening with your periods as well. So you need to ask a few questions of your health food shop or you can call us up and ask whether it would be the most appropriate thing for you here. But again, you know, you can look at a good probiotic.
Check it out with your doctor
If there's a really big change of smell, big change of color, it's a good idea just to check with your doctor. You can end up with a low grade infection that might need treating in some way so it's always best to know what's going on and then it's much easier to treat it yourself if you want to.
Symptom 6 - Pelvic pain
And number six, but definitely not least, is pelvic pain. A lot of women can experience pelvic pain, and again it can just be that discomfort thing where you're sitting down and standing up, but any pain that goes on, that doesn't abate or gets worse then it's really vital, please, please, please go and get this checked out by your doctor. It can be a whole number of things.
One of the most common one is something called a prolapse and here what happens is is that the muscles that hold up all the pelvic organs such as the bladder, the bowel and the uterus become a little bit weak and when that happens, the bladder or the bowel or the womb itself can shift position, it can put pressure on the vagina. Your womb can actually start to fall into the vagina and this can cause an awful lot of pain.
If you're getting low mucus as well, if everything is starting to dry out, then the vagina itself can start to collapse in on itself, and again, that can cause a lot of pain when sitting and standing up, when moving and when exercising. So it's a good idea just to get this checked out by your doctor, A, to make sure that there's nothing going on but there may be something they can do to help you with this.
So in general you can see now how just something, what we term as so simple as a reduction of oestrogen, can have a huge effect on all aspects of your vagina health.
What else can you do?
There are other things you can do to look after your vagina generally and for those of you sitting there who are just approaching the menopause, you may be in the peri-menopause, the time to work on your vagina is now if you can because the more work you do before your oestrogen levels start to drop too much then the less likely you are to get problems.
Phytoestrogen products & water
So, what are these things? We're looking at possibly phytoestrogen product if it's appropriate for you at this particular time, definitely do the vaginal probiotics, maybe take a course once every six months. Remember loads of water. Dehydration will actually affect the vagina as well, so remember to drink plenty of water on a regular basis.
Look at exercises, very important, and the exercises that will strengthen the pelvic girdle are the Kegel exercises. All you need to do is Google "How to do Kegel exercises" and there'll be load of sites will come up to tell you how to do it.
Pilates can be absolutely fabulous for this particular area and even getting a private lesson can be a good idea because a really experienced practitioner will be able to show you very specific exercises that you can do on a daily basis that can possible save you a whole lot of trauma later on when you're going through the menopause.
Yoga is another one as well. There's very specific exercises you can do like the Kegel exercises that can help to keep everything really strong.
Check your underwear & personal care products
Other things, please wear cotton knickers purely because if there's a change in the level of bacteria in the vagina, you want to keep the air circulating, you want to keep everything as fresh as possible so try not to wear any man-made fibres if at all possible and, as I said before, don't use any of these over-the-counter vaginal deodorants and watch what kind of soap and shower gel you're using.
This area is so sensitive and, you know, if you're showering a couple of times a day, you're putting loads of chemicals on an area that really doesn't want them at all, so it's a good idea at this point to go for more natural or organic personal care products.
So I hope that has given you a little bit of insight into our vagina health and what happens during the menopause and I will look forward to seeing you next week for another A.Vogel Talks Menopause.