What’s the menopause symptom no one talks about?
Vaginal dryness is one of the most common yet least talked about symptoms of menopause. It affects one in two postmenopausal women and often begins in perimenopause—research suggests that one in five women aged 40–45 experience it. Despite how common it is, many women don’t seek help, either assuming it’s just part of aging or feeling too uncomfortable to bring it up with their doctor. It’s often considered the last taboo of menopause—but it doesn’t have to be. The good news? Unlike some of the more challenging symptoms of menopause, many women find vaginal dryness improves with the right approach.
Symptoms can go beyond just dryness. Women may experience itching, soreness, burning, pain during sex, increased UTIs, nighttime trips to the bathroom (nocturia), thinning or splitting skin, discomfort wearing tight clothing like jeans, and even reduced sexual sensation. Vaginal dryness doesn’t tend to improve on its own—it often worsens with age. That’s why it’s so important to talk about it and find solutions.
WHY DOES THIS HAPPEN?
The vagina is rich with oestrogen receptors that help regulate natural lubrication. But as oestrogen levels fall in menopause, the vaginal walls thin, blood flow decreases, and moisture levels decline, leading to dryness and discomfort.
Unlike other parts of the body, vaginal moisture isn’t produced by glands but by tiny blood vessels in the vaginal walls. These vessels filter fluid from the blood, which seeps through to keep the vagina hydrated. This process, called transudation, is important for vaginal health.
The vagina also has its own microbiome, a community of bacteria that helps protect against infections. The "good" Lactobacillus bacteria play a crucial role in maintaining vaginal acidity by producing lactic acid, which keeps the vaginal pH low (around 3.5–4.5). This acidity helps prevent the overgrowth of harmful bacteria and pathogens. But when oestrogen levels fall, the vagina produces less glycogen— the food that Lactobacillus need to survive. As a result, pH levels rise, good bacteria die off, and infections become more common.
To complicate matters further, the vagina and rectum are naturally close together, making it easier for faecal bacteria like E. coli to reach the urethra, and cause urinary tract infections (UTIs). This isn’t about hygiene—it’s about biology. The vaginal microbiome plays a key role in protecting both the vagina and the neighbouring urethra, the opening to the bladder. Most UTIs are caused by E. coli, which migrate from the rectum into the urethra. Wiping from front to back and avoiding thong underwear can help reduce bacterial movement, but basic female anatomy puts the anus and vagina too close together to entirely stop this bacterial passageway. Just know that infections are rarely a sign of poor hygiene; instead, they are usually a sign of lowered defences.
WHAT YOU CAN DO
Diet:
Eat whole, traditional soy foods like tofu, tempeh, miso, and edamame.
Add 2 tablespoons of freshly ground flaxseeds to your daily diet.
Increase lubrication from foods such as oily fish (salmon, mackerel, anchovies, sardines, herring), flaxseeds, walnuts, sesame seeds, and pumpkin seeds.
For vitamin E, enjoy almonds, walnuts, avocados, sweet potatoes, tomatoes, salmon, mackerel, and blackberries.
Include vitamin A rich foods such as liver, sweet potatoes, carrots, spinach, kale, pumpkin, and red bell peppers in your diet.
Stay hydrated by drinking plenty of water.
Avoid substances that dry out mucous membranes, like antihistamines, alcohol, caffeine, and diuretics.
Lifestyle:
Choose breathable underwear made from natural fibres.
Sexual intercourse and masturbation can help improve dryness by increasing blood flow and strengthening the vaginal muscles and blood vessels. Staying active also helps!
Skip the regular soaps, as they are often too alkaline and can irritate the vulva and cause dryness. Use warm water and a pH-friendly wash like Kolorex Vaginal Care Daily Wash.
Avoid douching or other forms of internal cleaning, as they can disrupt your vagina's natural balance and self-cleaning ability.
Use lubricants and vaginal moisturizers without parabens or perfumes, which can irritate the area. Try YES VM Vaginal Moisturiser, YES WB Lubricant, Dr. Wolff’s V-san Moisturising Cream, or Olive and Bee Intimate Cream.
HOW YOUR PRACTITIONER CAN HELP
Topical therapeutics:
Sea buckthorn Oil: Rich in omega-7 fatty acids, it can help improve vaginal moisture and relieve dryness, especially with long-term use.
Fennel Seed: A study showed that fennel, applied as a vaginal cream for 8 weeks, improved vaginal cell quality, reduced abnormal cells, and balanced vaginal pH. IMPORTANT: Do not use fennel seed essential oils, as they are too concentrated and may cause irritation or harm.
Vaginal Vitamin D: Research shows it can improve vaginal dryness, reduce tissue paleness, ease pain, and restore pH balance. However, you should not use just any Vitamin D in the vagina. Speak with your practitioner first and ask about checking your Vitamin D levels.
Supplements to consider:
Probiotics: Oral and vaginal probiotics, specially formulated for vaginal health, may help maintain a healthy vaginal microbiome and defend against infections.
Sea buckthorn orally to support vaginal mucus membrane health.
Ensure optimal Vitamin D levels
Other Considerations:
Vaginal Microbiome: Speak to your healthcare practitioner about assessing your vaginal microbiome. A vaginal microbiome test can provide valuable insights into the bacterial balance in the vagina, helping to guide more targeted treatments and better manage symptoms.
Vaginal Oestrogen: Your doctor may prescribe localized vaginal oestrogen, available as a cream or pessary. This treatment helps increase moisture, improve vaginal wall thickness, and boost blood flow. As it remains local, it is generally considered safe for many women. However, if you have a history of hormone-sensitive cancer or other concerns, speak to your doctor to determine if this option is right for you.
Important: Due to the increased risk of genitourinary issues in women during this age group, it is vital to fully investigate any new or worsening symptoms, such as pain, post-menopausal bleeding, malodorous vaginal discharge, dysuria, or haematuria.
Bobbie X