Can lubricants help menopause vaginal dryness?
Vaginal dryness is a common condition that is particularly prevalent during and after menopause, and the impact on interpersonal relationships and quality of life can be significant. However, this condition is often under-reported and under-treated due partly to embarrassment on behalf of the patient and, until the 2015 publication of the National Institute for Clinical Excellence (NICE) Guideline on the Diagnosis and Treatment of Menopause, there was a lack of evidence-based guidance for GPs.
Vaginal Moisturisers and Lubricants for Menopausal Dryness and Atrophy
Topical oestrogen in the form of a tiny pessary (Vagifem) is one option for the long-term treatment of vaginal dryness, a symptom which unfortunately does not decrease post-menopause. NICE recommends that topical oestrogen can be used either alone or with vaginal moisturisers and lubricants for atrophy. However, some women under the care of GPs and consultants are finding that since the recommended dose was reduced from 25mcg to 10mcg twice a week after the initial daily application for 14 days, the treatment is less effective at reducing the symptoms.
NICE seems to have recognised this possibility and recommends “If vaginal oestrogen does not relieve symptoms of urogenital atrophy, consider increasing the dose after seeking advice from a healthcare professional with expertise in menopause.”
Some women find that they are not given the support they seek for dealing with vaginal dryness and atrophy. It is not unknown for GPs and online advisory sites to recommend KY, Vaseline or simply ‘a lubricant’. However, there is a clear distinction between lubricants and vaginal moisturisers and many lubricant manufacturers and even some moisturisers have been formulated with ingredients that can upset the delicate vaginal environment and lead to irritation, thrush and urinary tract infections.
Always look for the pH of the product on the pack. All vaginal and vulval products should be acidic and in the region of pH4 – 4.5. Anything higher than this can leave you at risk from infections. Whilst glycerine is an excellent product for external skin, it is known to be an irritant to sensitive vaginal and vulval tissue. Propylene Glycol can also irritate. Parabens which are used in water-based products as a preservative have been found in breast tumours and are known to be hormonal disruptors. There is no proven cause and effect between parabens and breast cancer but it is wise to avoid them, especially in intimate products. Sucrose, sweeteners, perfume and lubricants designed to tingle or stimulate should be avoided by post-menopausal women with vaginal dryness.
Vaginal Moisturisers are designed to provide symptom relief for moderate to severe vaginal dryness and atrophy and are used regularly over a long period of time. Lubricants are suitable for women with mild to moderate dryness to help make sex more comfortable.
Combining vaginal oestrogen with a non-hormonal pH-balanced vaginal moisturiser is an alternative option for those who would rather not increase the oestrogen dose. It is advisable to use the moisturiser at a different time of day, in case it has an effect on oestrogen absorption. There are a number of moisturisers available on prescription or from pharmacies, but it is important to find one that suits you and does not cause irritation due to the formulation.
For women who are unable to use oestrogen due to having had an oestrogen receptor-positive cancer, experienced side effects from oestrogen use, or who simply wish this avoid this treatment, there is some evidence to suggest that when applied on a regular basis, vaginal moisturisers are as effective as a topical oestrogen. It is important to stress that both of these treatments need to be used on a long-term basis. The painful symptoms of vaginal atrophy will re-occur upon cessation of the treatment.
YES VM natural vaginal moisturising gel and YES water-based vaginal lubricant are both free from glycerine, glycols parabens and all known skin irritants and are available on prescription or directly from The YES YES Company. www.yesyesyes.org
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