Aunt Vadge: menopause is tearing me apart

Hi Aunt Vadge,

I am 54-years-old and am menopausal – I have a Mirena coil fitted for HRT combined with Climaval 2mg [oestradiol, E2] pill. I have been using this method since I turned 46/47. My coil is checked every four years.

Recently I have been suffering with tearing/splitting of the vaginal skin specifically around the top/sides of my clitoral hood and vaginal opening. These cuts are caused by the lightest touch, from wiping or sexual arousal and are extremely painful.  I have tried emollients and water based lubricants but to no avail.

How can I resolve this problem?

Sincerely,
Split

___________

Hi there Split,

Your question is great – many women are on hormone therapy, but still suffer a collection of hormone-related maladies. Vaginal dryness and cracking is a classic low-oestrogen problem, and locally applied creams and emollients won’t help much except to soothe, since the problem is on the inside, not the outside.

It sounds like you are suffering from low oestrogen, despite taking oestrogen, which means you have a few appointments ahead of you to manage your post-menopause body and hormone levels, and to restrategise your medication. This may involve a rejig, or going off the meds completely and removing the IUD, since it may no longer be serving its original purpose of birth control or period/hormone control.

Menopause is not a disease and does not need medicating, but while unpleasant symptoms are a fact of life, thankfully we do have a range of solutions. Menopause is a transition phase, and does not tend to last for a decade, though the hormone drop-offs can be slow over many years. Menopause as the transition lasts usually a few years at worst, then it’s over, and the third phase of your life and body begins.

You may have another issue either interfering with your metabolism of the hormones you are taking, or in fact a local problem like a fungus. Only a review by your healthcare practitioner will determine this. There are so many other great strategies that you can incorporate into your life to not only increase your oestrogen levels using food and useful plants, but to improve the integrity of your tissue so it is more hardy and protective.

Your diet may need some work, and I would hazard a guess that your primary care physician has little interest in guiding you here. This is where an holistic practitioner who specialises in diet can help immensely.

Hormone therapy

You don’t mention why you are on hormone therapy, but it could be one of two reasons: 1) After experiencing unpleasant menopausal symptoms, you were medicated at age 46 to counteract them and just never stopped, or 2) you are missing one or both ovaries due to a malfunction of some kind (cancer, growths, disease) and have been supplemented until menopause.

You have a hormonal IUD fitted into your uterus for local and systemic (blood and tissue) progestin and take Climaval, a form of artificial oestradiol, an oestrogen. This is designed to keep your body in a fertile-type state to mimic the fertility-supporting functions of your ovaries when the ovaries aren’t doing it.

Dealing with the low oestrogen as a method to healing your vulva

One of the many impacts of low oestrogen is a significant loss of integrity and function of the skin as a barrier. This loss of skin tone and function is a classic sign of very low or no oestrogen. Low skin function means skin becomes dry and thin, and due to less water, collagen and skin cell proliferation, cracks and breaks easily, sometimes at the slightest touch, as you are experiencing.

Vaginal tissue is heavily dependent on oestrogen for keeping it juicy and high-functioning, so one of the first and most obvious places women start to see the effects of low oestrogen is in their vaginal and vulvar tissue. You are not alone here.

The straightforward answer to this is to ‘increase oestrogen levels’, which is true, but you can’t just shovel in oestrogen and cross your fingers, as free oestrogen can really do some damage.

Naturopathically, the strategy of naturally increasing oestrogen levels through food and if necessary, short-term using herbal formulas, is generally the preferred route but there is no right or wrong here, just whatever works for you – a combination of both strategies works very well for many women.

Any changes to your medication can only occur after a thorough discussion with your doctor about your symptoms, because there may well be another reason, a concomitant issue (fungus, autoimmune disease, or a handful of others) that is causing your vulvar skin to crack at the slightest provocation. Care from an experienced, qualified naturopath who is well-versed in post-menopausal women can be really useful for these types of conditions where medical solutions are limited.

Past increasing oestrogen levels

There is mounting evidence that post-menopausal women’s bodies really benefit from a few key components, and this includes the proper structure and function of your skin – you not only need the necessary nutrients for proper skin function, but to be able to digest and absorb these from food, making your digestive capacities (as one example) of great importance.

Elements to a healthy postmenopausal body are:

  • Exercise, at least once per week, preferably three times. Keeping your blood pumping (even gently) is essential for keeping your cells juicy.
  • Sexual activity has been shown to unequivocally increase and maintain the function of your vaginal cells, and is considered the best method to keeping a dry vagina at bay. Obviously in your case this is currently impossible, since you are getting split every time you move, however with some specific treatments for your oestrogen levels and if appropriate, other elements of your health and wellbeing, this should correct itself.
  • Plant oestrogens – wholefoods like tempeh, nuts, seeds, soy products, wheat, dairy, oats… (the list goes on) contain plant oestrogens which have a significant role to play in managing the effects of low oestrogen on the ageing body.  The phyto-oestrogens are found in wholefoods (don’t get sucked in to taking soy supplements – wholefoods act in the body in a synergistic fashion).
  • Being social. Having friends and participating in life with laughter and fun is medicine for your body and soul.
  • Eating well and caring for your digestion. Eat good food that supports your ageing body and takes lowered digestion and overall functioning into account. Talk to your naturopath about how to maximise your diet. Work with your body, not against it.
  • Manage your expectations. Your body is not going to behave like it used to, and you need to understand this and go with it – learn what to expect, and form a good relationship with a practitioner you trust, and use them as a resource for getting old with your body intact.

If you have any more questions, let us know! We would love to find out what the outcome was.

Warmest regards,
Aunt Vadge

Jessica Lloyd - Naturopathic Practitioner, BHSc(N)

Jessica Lloyd - Naturopathic Practitioner, BHSc(N)

Jessica is a degree-qualified naturopath (BHSc) specialising in vulvovaginal health and disease, based in Melbourne, Australia.

Jessica is the owner and lead naturopath of My Vagina, and is a member of the:

  • International Society for the Study of Vulvovaginal Disease (ISSVD)
  • International Society for the Study of Women's Sexual Health (ISSWSH)
  • National Vulvodynia Association (NVA) Australia
  • New Zealand Vulvovaginal Society (ANZVS)
  • Australian Traditional Medicine Society (ATMS)
Read more about Jessica and My Vagina's origin story.