Menopause: Itchy skin, irritation and how to prevent vaginal dryness

It’s no secret that the perimenopause and menopause can cause a seemingly endless array of physical and emotional symptoms. While changes such as hot flushes and insomnia are well-publicised, you might be unfamiliar with the more intimate side effects of the menopause. This is because unfortunately, speaking about women’s health issues remains a taboo. This can lead to vaginal dryness being left untreated and undiagnosed. 

The decline in oestrogen levels (the hormone responsible for maintaining the female reproductive system) during menopause can bring uncomfortable changes to the vulva. Rest assured, vulva changes throughout the  menopause are very common. Less oestrogen can thin the lining of your vagina, and tissues of the vulva can become drier, itchy and less flexible.  

If you are experiencing vulva dryness, a sore clitoris area, menopausal vulva irritation or postmenopausal vulva itching, you are not alone. Many women have overcome these symptoms, and you can too.  

We consulted with Dr. Alison Macbeth, a Menopause Specialist, to find out how you can care for your intimate skin through the menopause and beyond. 

Lots of women experience changes to their vulva and intimate skin during the perimenopause and menopause. It is important to monitor and manage these changes to maintain your personal health and wellbeing. Yes – it is possible to feel great, even in the clutches of the menopause. Some of the most common changes include: 

• Reduced vaginal secretions (less lubrication, although watery discharge can sometimes occur) 
• Vaginal skin irritation, and itching
• Menopausal vulva irritation , itching, dryness and loss of fatty tissue 
• Increased vaginal pH (due to lower oestrogen levels)
• Thinner, more fragile vaginal lining and intimate skin (due to lower oestrogen levels) which can often get painful, irritated and can occasionally bleed.

Menopause Hormonal Changes

During a woman’s fertile years, the vagina is supplied with lots of oestrogen. It has a thicker lining and more folds, allowing it to stretch for sexual intercourse and childbirth. During and after the menopause, less oestrogen causes the vaginal lining and intimate skin to thin, making it less flexible and more susceptible to discomfort and injury, especially during sex. 

 As women enter the postmenopause, oestrogen is no longer produced.  

Many women fail to understand that their symptoms are due to lack of oestrogen, and miss the opportunity to access simple and effective treatment that can not only relieve symptoms but reduce future risk of UTIs - a common cause of urosepsis in elderly women.  

Fragile vulvovaginal tissues are highly vulnerable to tearing, bleeding and injury – not to mention irritation. This discomfort can have a serious impact on day-to-day life. Vulva changes in menopause can also have a detrimental effect for women that want to maintain a healthy sex life during and beyond the menopause. It can also make it uncomfortable to exercise especially riding a bike due to loss of fatty tisue to the vulva. 

You may come across the older term of vaginal atrophy when researching these issues. However this term is no longer used, and the term Genitourinary Syndrome of Menopause (GSM) is preferred to show the vulva, vagina, urethra , bladder and pelvic floor are all affected by lack of oestrogen. 

All of this might sound scary, but vulva changes are something many women have to navigate during the menopause. By arming yourself with information you can tackle vulva discomfort and irritation head on, empowering yourself to feel your best during this important life stage. 

The following tips can help alleviate vulva changes and vaginal skin irritation during the menopause: 

Even before the menopause, many women find that everyday products such as washing detergents, fragranced soap, scented oils, bubble bath, bath bombs, talc, feminine spray and deodorants can cause vaginal skin irritation.  Your sensitive menopause skin will be even more susceptible to irritation from these kinds of products, so avoid them as much as possible. 

You should also take extra care when cleaning your vulva, to lower the risk of irritation or a dry vaginal area. To minimise discomfort, use only warm water, or a non perfumed emmolient to cleanse the area. After a bath or shower, try not to rub the area dry vigorously with a towel or flannel, but pat dry gently to minimise menopausal vulva irritation.

To minimise any vulva sensitivity during the perimenopause and menopause, try using a mild detergent for washing your underwear, and choose 100 percent cotton underwear where possible. Avoid wearing nylon or other synthetic fibres, as these can make menopause vaginal itching and sensitivity worse. 

When choosing products for incontinence, look for breathable incontinence pads that don’t contain fragrances or dyes, such as TENA Lights for Sensitive Skin. These should help maintain intimate skin health, preventing any menopausal or postmenopausal vulva itching and soreness. 

Throughout the menopause, vulva irritation can occur as the skin becomes dry, due to fewer vaginal secretions. Menopause-related dryness can often be managed with topical vaginal moisturisers, and lubricants for intimacy, which you can apply locally to intimate skin to keep vulvovaginal tissues healthy. These products are manufactured for use in the vagina, and are free of irritant additives making them gentle on the skin. They can also help to rejuvenate the vulva tissue, renew moisture.

Dr. Macbeth advised us that it’s best to avoid common over the counter intimate lubricants, as these often contain parabens, glycerine and other ingredients which can be very irritating to the vagina. 

The use of local oestrogen in the vagina is a very effective solution that relieves symptoms of vaginal dryness, and it can also be applied to the vulva.  

Its important to note that this is not the same as systemic HRT and does not increase the risk of breast and womb cancer, or blood clots. Vaginal oestrogen comes in various forms such as: 

• Creams 
• Tablets 
• Pessary 
• Rings 

Using these will restore oestrogen directly to the vulva, vagina, urethra and bladder neck. 

This can help by: 

• Improving elasticity 
• Improving dryness 
• Reducing urine infections  
• Alleviating discomfort  

Most women can safely use vaginal oestrogen, but if you have had a hormone sensitive cancer then please discuss with your health care professional. 

Pelvic floor exercises can improve blood flow to the vulva, vagina, urethra, bladder and pelvic floor and will also help with the Genitourinary syndrome of Menopause. 

If menopause vulva irritation is getting you down and you are unable to get relief after using home treatments, don’t be afraid to speak to your doctor. They may refer you to a vulva dermatologist or gynaecologist for specialist treatment.  

While menopause vulva irritation is very common, you should always seek professional help if you experience symptoms including; 

• Unusual vaginal discharge  

• Abnormal bleeding between periods or after sex  

• Rashes, sores/ulcers or redness on the vulva  

These could all be a sign of something more serious. Even if you’re unsure, always seek the advice of your GP.

If you feel that you need more advice on tackling vaginal dryness or learning how to avoid sore skin when dealing with menopausal bladder leaks, TENA is here to help.