There are so many changes to your body when you’re going through the menopause transition. One which is not commonly talked about is noticing a difference in your skin. Anecdotally, many women tell me that alongside noticing some skin sagging and wrinkles, their skin seems to become more delicate and sensitive. This can be a real problem for runners whose skin is regularly exposed to the elements, to friction, to sweat and to frequent washing.
I’ve decided to do a little mini-series looking at the skin changes in perimenopause that can affect us as runners. You can read Part 1 which covered skin chafing by clicking here. This is Part 2 and we’re going to look at vaginal atrophy.
What is vaginal atrophy?
The word ‘atrophy’ means wasting away or thinning. There are oestrogen receptors in the vagina and vulva and when good levels of oestrogen are present they make sure that there is good blood flow to the area, that the tissues are thick, bumpy, elastic and moist. As oestrogen levels reduce in peri and post menopause, this leads to changes in the vulval and vaginal surfaces. Plumpness, elasticity and lubrication are all reduced.
Vaginal atrophy causes symptoms in more than half of post menopausal women and 15 per cent of women before the menopause so it’s a huge issue. It’s also one which isn’t talked about much as it can be a sensitive topic, there’s an understandable hesitancy to bring up your dry vagina in conversation. We shouldn’t accept this as a normal part of ageing and just put up with the symptoms, treatment is available!
You might also hear the terms atrophic vaginitis or vulvovaginitis. Basically putting ‘itis’ on the end of a word indicates inflammation. (Think appendicitis or sinusitis for example). It’s easy to see how a dry vagina or vulva can become inflamed.
What are the symptoms of vaginal atrophy?
You may not have any symptoms from the condition but if you do, you might experience:
- Painful sex
- Discomfort during cervical screening
- A dry vagina
- Burning sensation in the vagina
- A mild vaginal itch
- Needing to pee more often
- Frequent urinary infections
- Urinary incontinence
- Frequent vaginal infections
- Spotting of blood (never assume this is due to atrophic vaginitis – get checked)
How can vaginal atrophy affect running?
Running is a very repetitive movement. If the tissues of your vagina and vulva are dry, the friction from long runs can irritate them and cause pain, itch or spots of blood (again, never assume bleeding is from this).
Lower oestrogen levels and the changes in the tissues makes the pH of the vagina less acidic. This can increase the risk of infection so you might find you get more infections such as thrush or more urinary infections than you used to.
If you’re cross training on a bike, then sitting on the saddle can feel uncomfortable too.
Can I get rid of vaginal atrophy?
Before we look at treatments, there are some simple things you shouldn’t do. Avoid over washing your vulva, douching your vagina or using perfumed washes (even if they say they’re for your ‘intimate areas’). This goes for all women with or without vaginal atrophy or atrophic vaginitis. Runners tend to have a lot of showers and get extra sweaty, so it’s easy and tempting to over wash. Plain water is fine.
Moisturise. The first thing you can do is to add moisture back to the vagina with a vaginal moisturiser. You can buy these over the counter and either use them regularly or whenever you need to. You could for example, apply it before your long run. Make sure you buy one which is fragrance-free. Don’t use a moisturiser that’s not designed for your vagina. Your anti-chafing skin lubricant that you use on your inner thighs for example, is not suitable. If sex is uncomfortable then use a water-based lubricant. Regular sex will actually help with keeping your vagina healthy.
Replace oestrogen. Rather than just soothing the dryness with a moisturiser, you can treat the cause and replace oestrogen. Systemic (full body) Hormone Replacement Therapy (HRT) is one option but oestrogen replacement can be done locally, directly to the dry tissues themselves with a vaginal oestrogen cream, gel or pessary (tablet which you insert into the vagina) and this is usually the first choice treatment. There is also a vaginal ring which sits high in the vagina and slowly releases oestrogen too.
In the UK you can now buy a vaginal oestrogen tablet over the counter if you are over 50 and post menopausal. If you need other preparations or there is any doubt as to the cause of your symptoms then you should see a doctor who will want to ask you some questions and examine you, to make sure there are no other reasons for your discomfort (read on). You’ll usually be asked to use a vaginal oestrogen daily for a couple of weeks and then reduce to twice a week for maintenance. It’s suitable for the majority of women, can be used long-term and in addition to HRT if you still have vaginal symptoms. You should expect to see an improvement in two to four weeks but it may take 12 weeks to get the maximum benefit.
What else could it be?
Don’t self diagnose this condition, go and see your doctor. Remember, you don’t need to shave your legs, wax your bikini line or wear your best knickers to get checked, just make the appointment.
You can see from the list of symptoms why it’s easy to make the wrong diagnosis:
- If you have an itch or vaginal discharge, you need to have a vaginal infection excluded.
- If you have recurrent urine infections you will need to give a urine sample and possibly have other investigations.
- It’s a tricky area to examine yourself and if you have discomfort then you may have a skin lesion or a cyst that requires different treatment.
- If you’re leaking urine then you need to be examined to assess your pelvic floor and check for prolapses.
- Any unexpected vaginal bleeding such as between periods, after sex or after the menopause needs to be checked out, usually the cause is harmless but very occasionally it can be something serious such as a cancer.
Once the doctor is certain that vaginal atrophy or atrophic vaginitis is the diagnosis then treatment can start and it can make a HUGE difference. If you don’t want to, or can’t take full HRT, then topical (applied to the skin) vaginal oestrogen might still be an option for you so don’t rule it out and have a conversation with your doctor.
Don’t put up with symptoms or assume this is how things are with age. Don’t let this condition ruin your running!
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