After the Menopause
What is the postmenopause?
This is the stage of every woman's life that follows the menopause, or her last menstrual period.
A woman is definitely postmenopausal when she has not had a period for at least a year. Most women in the UK go through the menopausal transition between the ages of 45 and 55, with the average age of the last menstrual period being about 52.
After the menopause the ovaries cease to produce the main female hormone, oestrogen, and its absence can produce a wide range of symptoms.
In the short-term many women experience hot flushes and night sweats and many emotional changes. In the long-term lack of oestrogen may predispose many women to osteoporosis. Most women are aware of these problems, and are able to openly discuss them with their healthcare providers and feel comfortable enough to debate with their friends and family as to what approach they will choose when coping with these symptoms.
Many women also experience urogenital problems such as vaginal discomfort and urinary incontinence in the years after the menopause, but most find it hard to admit to these symptoms even with their closest friends, let alone to ask their doctor or nurse for help.
Medical terminology for the array of problems faced by so many women is confusing and the aim of the following information is to try to explain some of the urogenital problems of the postmenopause.
Urogenital atrophy - "Vaginal atrophy"
Vaginal dryness, soreness, itching and painful sex
Without the production of oestrogen by the ovaries, the skin and support tissues of the vulva ("lips") and vagina become thin and less elastic. This is an inevitable consequence of the menopause and the majority of women will experience some form of symptoms.
Vaginal dryness is commonly the first reported symptom. This is due to a reduction in the production of mucus by the glands of the vagina. Thinning of the vaginal and vulval skin can follow, which in turn makes them more easily damaged. This damage can occur during sex, especially if lubrication is also poor and even quite gentle friction can cause pain and discomfort. If the vulval lips are thin and dry, they can often rub on underwear causing soreness. Many women also dislike the outward changes in the appearance of the vulva ('lips') as they lose their plumpness. It is not unusual that for many women, sex becomes difficult, painful, embarrassing, and sometimes unwelcome!
Alteration in the normal vaginal discharge is something noticed by most women after the menopause and also rarely discussed. Without oestrogen the pH (acidity) of the vaginal secretions changes and the normal discharge becomes more alkaline (like caustic soda!). This pH affects the balance of the micro-organisms in the natural secretions which in turn suppresses the normal levels of "good" bacteria (lactobacillus). The discharge changes in nature, becoming watery, discoloured and slightly smelly. This often leads to vaginal burning and vulval irritation.
Often women buy "over-the counter" anti-thrush treatments, which may not be effective as this is not a fungal infection. Sometimes these creams can themselves sensitise the vulval skin and make the problems worse. Other women can become prone to recurrent attacks of candida ("thrush") and so it is important to be able to distinguish between the two conditions.
Many women can use oestrogen cream or pessaries that is applied to the vulva and vagina (topical HRT). Because this is only applied to the area where it is required, the risks associated with hormone replacement are significantly reduced. Oestrogen replacement can help to rebalance the pH and also improve the dryness and soreness experienced.
Pelvic floor changes and prolapse
Many postmenopausal women become aware of "ballooning" or bulging of the walls inside the vagina, or even of a feeling of descent of the neck of the womb. Others simply experience a generalised pelvic dragging sensation. About half of post-menopausal women are found to have weakening of the front wall of the vagina (anterior vaginal wall prolapse); about a quarter have similar problems with the back (posterior) wall, and one-fifth with the highest part of the vagina.
The muscles and ligaments of the pelvic floor (which should normally support the womb, bladder and other organs like a trampoline) are also oestrogen-sensitive, and changes in collagen, due to oestrogen deficiency, have a profound effect on the support mechanisms of the pelvic floor.
The protective covering of the clitoris is often affected by the changes in the collagen of the vulval skin, and the clitoris itself can become sore and traumatised. These skin changes are often so profound that genuine skin conditions emerge ("dermatoses"), and may need separate treatment.
Many women find these changes make them uncomfortable on a daily basis. These changes can also be a precursor to the process leading to problems with the bladder and "waterworks".
For more information on prolapse, please visit our main Prolapse section
Lower urinary tract symptoms
As they get older many women may find they have problems with their urinary tract ("waterworks").
Some suffer from stress urinary incontinence; leakage on coughing, sneezing, exercising etc. Urge incontinence is even less commonly referred, this is where women have difficulty "holding on" once they sense that they need to empty their bladder. They may also leak and start to pass urine before they can get to the toilet. In order to avoid these symptoms, some women tend to start going to the toilet more frequently to avoid leakage.
If you would like more information on bladder problems, please visit our main Bladder Problems section.
Recurrent urinary tract infections (UTIs)
Commonly called cystitis, this is another form of "waterworks" problem that affects women of all ages, but increases with age with many elderly women being particularly troubled. This is often caused by a change in the pH (acidity) of the vagina, which results in a change in the balance of micro-organisms. Bad bacteria flourish and can easily move into the bladder as well.
Recurrent urine infections can also be helped by oestrogen replacement. It is also important to seek an expert opinion about the recurrent infections in order to rule out any other causes, such as prolapse, bladder stones or being unable to empty the bladder effectively.
Management of urogenital problems
Recognising that these problems are more widespread than most women imagine, and feeling able to talk to friends, family or even to a nurse or doctor about them is one thing, but is there any point?
YES - there are lots of ways to help women with incontinence, prolapse, cystitis and recurrent infections. Either ask your GP to refer you to the Community Continence Advisory Service, a specialist physiotherapist, or the gynaecology department for an expert opinion.
The final message
Many women may have postmenopausal problems which could affect their vulva, vagina and waterworks, but they should not feel ashamed to talk about the subject or even to ask for help. Healthcare Professionals dealing with women at this stage of their lives are very aware of these conditions and their seriousness, as well as the effect they can have on the quality of women's lives and relationships.
You should never be afraid to ask for help, you are not alone and there are many things that can be done to help you. Please use the link boxes below to browse information on potential treatments or products to help manage symptoms. To find out more about symptoms like urgency or stress urinary incontinence, please visit our main Bladder Problems page and use the drop down menus to look for information.Last updated: 02/12/2011
After the Menopause
Info and Advice