Good news – ESSENCE’s “Ask An OB-GYN” series is back to bring you very public answers to some of your most private questions. When sexual and vaginal health concerns arise, renowned Obstetrics and Gynecology physician Dr. Tosha Rogers wants to ensure you have the answers you need to feel at ease. If you have a sexual health concern or question you want to swing her way, we’ve got you covered.  Email [email protected]with “Ask An OB-GYN” in the subject line and ask away!

Q: What are the vaginal changes that happen as women get closer to menopause? (unusual discharge, dryness, etc?)

A: Many changes occur in women with respect to menopause. People tend to think that menopause is a date when your menstrual cycle just stops and doesn’t come back. Not at all! Menopause is a process, for lack of better words.

Symptoms are:

  • Mental (irritability, moodiness)
  • Physical (difficulty losing weight, absence of menses, hot flashes, night sweats, bone thinning, poor sleep patterns),
  • Emotional (anxiety, depression), Sexual (decreased libido, vaginal dryness).

When it comes the vaginal changes, the most notable is vaginal dryness (also known as vaginal atrophy.) Due to a decrease in estrogen, the lining of the vagina (the mucosa) gets thin and dry. Sometimes it can crack and cause spotting or bleeding, especially after intercourse.

Speaking of intercourse, it can become a really miserable experience. Not only is there lack of desire, which worsens the vaginal atrophy (dryness) – the dryness and thinning associated with menopause (atrophy) can lead to tearing and bleeding after intercourse. Add all that up and you have yourself one miserable night of loving. There are no discharges that are associated with menopause. If there is discharge or an odor, a visit to the gynecologist is likely needed.

Back to the atrophy. Here is how I approach and manage this situation. Hormone replacement is a complex conversation and should only be offered if a patient is medically stable to receive it. Hormone replacement can be a daily oral treatment, which addresses all of the symptoms of menopause, or it can be vaginal cream which will relieve the vaginal atrophy. It works by replacing some of the estrogen to the mucosa (lining) of the vagina, making the skin thicker and moist. A question I always get is if there is a non-hormonal alternative (usually because the full explanation of hormone replacement has not been had). There are non-hormonal alternatives for hot flashes, but not for vaginal atrophy. The good news for my hormone fearful or cancer survivors is that the amount of hormone that’s absorbed from the vaginal cream is minimal – so no worries.

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