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?
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!”
NO ONE TALKS ABOUT IT.
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.
19 thoughts on “Scary stories around the menopausal campfire: vaginal atrophy”
So glad you’re writing about this common set of symptoms. After experiencing similar, but nervous about HRT, my setup is a 3-month vaginal ring (Estring) that delivers a low dose of estrogen, and a pea-sized bit of topical (external) estrogen cream (Estrace) when extra juiciness is desired. Here’s to good health and happy vaginas!
Thanks for sharing for the benefit of others, Cate! They don’t share these kinds of details, in popular culture, when showing vibrant, older women. It’s good for women to know they are not alone in figuring these things out and there can be options. A lot of us remember the scary information about HRT from decades ago, and my understanding is the knowledge has changed and how things are done has changed.
Yes — HRT is different now, still not for everyone with risk factors but I feel confident taking it. The progesterone is protective. (Originally it was just estrogen)
Yeah, I’ve read some about it and have some information from others going through similar situations. Certainly not for everyone.
The notes I read on my health website regarding my most recent trip to the gyne (this past May) contained that phrase, and seeing that depressed me to no end. My husband had prostate removal surgery 10 years ago, and the surgery also involved resecting his bladder…which basically gave him permanent ED. We found different ways to be intimate (“outercourse”), but that didn’t last long. So my sex life is over, and this is what I’m left with at age 58. I don’t feel like an “old lady,” but I sure did when I read those words. Sorry to bring everyone down.
Have you tried any of the creams or gels etc? It took me a little while to feel better. It’s hard — I’m sorry you are having such a hard time
Thanks, Cate. 🙂 The issue is basically my husband losing his sex drive after the prostatectomy and bladder resection. My using creams or gels isn’t going to help with that.
Oh, I’m sorry, Julie — that is really tough.
Thanks again, Cate. I really appreciate your writing…and support.
I’m rather enjoying (if reading about all the horrific things that are possible/likely to go wrong in menopause can be described as enjoyment) Jen Gunter’s book The Menopause Manifesto, in spite of the horrible review it got here recently. I personally wasted no time suffering with hot flashes before I started HRT, and I’m certainly hoping it will forestall some of the other horrors awaiting me, but my expectations have been tempered since the book. I’m very grateful we’re talking about these things now, if a bit disappointed to have lost my blissful ignorance.
Given the absolute nightmare stories of saddle issues that so many women of all ages experience, I wear padded cycling shorts and chamois cream for every ride, no matter how long – ESPECIALLY indoors, since you really can’t relieve pressure on the trainer in the same way as outside. I also put foam pads under the trainer legs for a bit more cushion. Hopefully my withering undercarriage will withstand another winter on Zwift.
Thanks for sharing this — and yes I don’t know what I was thinking with the bike shorts!!!
Thanks for noting that HRT isn’t for everyone. Given my family breast cancer history it’s definitely not for me.
Thanks for writing this. Important conversation to have.
I’m not sure why you wouldn’t wear bike shorts on a spin bike though. They’re way worse than a regular road bike. Less mobility and change in positions. I wear my most padded shorts riding on the trainer.
I think it’s because I don’t have as many bike shorts and they are less comfy on my tummy than yoga pants. But it’s dumb!
Bib shorts! My husband convinced me. My belly is super cranky, and often puffy, and my geometry of bones doesn’t help…everything seems to cut in except one super expensive pair of shorts made with a V in front and different material in front, not as tight. I found a place that makes “affordable” bib shorts ($40 USD) https://theblackbibs.com/collections/womens-collection (I’m not affiliated). I’m having a Pap/exam early next month, and wondering if atrophy is the reason that every vag exam I’ve had for probably a couple of decades now is just so painful it brings me to tears, regardless of lube, speculum size, etc. (that uterine biopsy a few years ago ranks as one of the most painful procedures I’ve had) Thanks for sharing this so candidly. Don’t have a lot of people I can talk to about things like this.
Thanks for sharing this. Been there (or somewhere similar!) and was shocked to find the doctors at my super feminist health centre knew almost nothing about the topic. The topical hormones work for me. I was really nervous about any hormonal treatment because of my reactions to the birth control pill, but it’s been fine — no side effects. $$$$ though. Lockdown also probably helped because it gave me space to figure out what the triggers were (physical and psychological).
It IS pricey — I should have mentioned that. I’m glad you have some relief though
Oh. My. God. WHY DO PEOPLE NOT TALK ABOUT THIS?? Nearly 51 and this is all news. Not very good news but I’m glad to know more than I did. This is going to take a while to process . . . thank you though.
I use a phytoestrogen cream. I went to a new gynecologist over the summer and he said I had less atrophy/dryness than he expected (10 years post menopause). I said I credited the phytoestrogen cream. He said: “I tell my patients those don’t work.” I will be looking for a different gynecologist.
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