Scary stories around the menopausal campfire: vaginal atrophy


Popular culture is full of scary stories about menopause: hot flashes. Night sweats. Losing your mind. Body shape shifting. Loss of libido. Drying up.

But you know what no one talks about?

Vaginal atrophy.

I’m kind of the menstruator-emeritus around here, and I’ve written plenty of posts about vaginas. (My old post about still menstruating at 53 still shows up in the top ten almost every month; my post about strengthening my pelvic floor using a cute little app game also has legs). But even I — deeply interested in uteruses and vaginas since I my Are you there god, it’s me Margaret, days, didn’t really know about vaginal atrophy.

I knew — from sitcoms and from Susan’s mom — about General Dryness and Lubrication issues. But like most people, I think, I assumed that this was just a sex-related thing, and would be easily remedied through good old fashioned lube.

The thing is? It’s not a sex thing. It’s a life thing. When Jen Gunter wrote about it for the New York Times a few years ago, the headline writer called it “the incredible shrinking vagina.”

What happens makes sense: as most vagina and estrogen-having people know, at menopause, your hormone levels decrease. As with other parts of your body, the skin of your vulva and vagina become thinner and lose elasticity. Your labia minora can also reduce in size. This is … not comfortable. (Gunter notes in the NYT piece that the appropriate medical term now is “Genitourinary syndrome of menopause” or GSM. Catchy, isn’t it? Yeah, “atrophy” paints a much more graphic picture).

I was mentioning my Vaginal Atrophy (as I do) at one of my few post-lockdown in person gatherings. The person I was talking to — a couple of years younger than I am — said “you know, my vagina is talking to me too. And my doctor keeps testing me for yeast and other bacterial things. But it’s NOT THAT. And she’s not listening to me!”


I am now officially in menopause, at 56. It’s been a year since I had a period. (Which is kind of sad. You don’t get to mark the last one like you do the first one!). Throughout the fall, I had constant hot flashes — like literally 20 a day — insomnia and night sweats. Really fun while in zoom all the time and experiencing global crisis.

But I also had this persistent burning, pain and general irritation in my vulva, especially in the top part of my labia. I didn’t even want to wear underwear, let alone be touched.

First I took some meds for yeast, and cut out sugar and took a lot of probiotics. I started wearing padded bike shorts for all of my zwift rides on my spin bike — even the short ones (Somehow it felt pretentious to put on bike shorts to ride in my house? Who knows the mind of the person living alone during lockdown). But it wasn’t yeast, or an STI, or friction. It was my shrinking vagina (and vulva).

So I did some googling, and finally came to understand what was happening. My vagina. Was losing. Its mind. (Well, its elasticity, but it amounted to the same thing). And it Wasn’t. Temporary,

Do you remember the Dr Who episodes with Lady Cassandra, who is only skin with a face stretched in a frame? Constantly bleating “mositurize me!” That’s what it felt like. A taut, anxious rasping situation.

I could have lived with the hot flashes. I’m old friends with insomnia. I’ve made peace with my slowing down body. But “taut and anxious” is not what you want in your vulva. I made an immediate appointment with my primary care provider.

My doc offered me various options for hormone replacement therapy. It’s not for everyone – some people don’t want it, and some have contraindicated risks. But I wasn’t in a risk group. And I took it all. An estrogen patch (Oh, estrogen, how I am beguiled by your sensual ways). Oral progesterone, a large round ball that regularly gets stuck in my esophagus, to protect me from reproductive cancers. (And to hit me over the head with sleepiness). AND estrogen cream for the vulva. (Which has less risk than patches and pills, for the record).

After a few weeks, I felt better. The hot flashes simmered down to one or two a day. I was sleeping the sleep of the righteous. But Down There? Better but not stellar. So I did some more googling. And came across vaginal and vulvar moisturizers. Kind of like lube, but more like a time release overall tissue humidifier.

So I went to the drugstore. You have to go to the aisle where they keep the tampons and condoms and yeast meds, and then bend waaaay down, right to the floor, sort of hidden away. A little selection of gyne gels. Nectar.

So now, the combination? Hormone replacement therapy (the full bouquet) plus whatever innocuous set of molecules makes up this fake lube? The patch and pill every day and gels and creams alternating a few times a week? For me, it’s the right mix. I’m comfortable. I’m… maybe not … juicy… but I’m Alive. And more important, not in pain, not irritated. And not a taut, anxious villain begging to be moisturized.

I’m a persistent person who doesn’t mind talking about my vagina in public. I suspect that a lot of other people are less comfortable talking about it. So here. It’s a thing. It’s normal. And there are options. Full HRT isn’t for everyone, but creams are lower risk, and the over the counter gels have almost no risk. All you have to do is bend down to the almost-hidden shelf.

What about you? How have you managed?

Fieldpoppy is Cate Creede, who is now obsessed with the images of flora and honey that show up when you search for images of vaginas.

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