Vaginal Atrophy in Perimenopause

Photo by Tj Holowaychuk on Unsplash

Vaginal atrophy (VA) is something that can happen during perimenopause and can be quite painful. Also know as Vulvo-vaginal Atrophy (VVA), because it includes the vulva and the vaginal lining.

What is VA? 

Simply put it’s the thinning of the vaginal wall and tissues of the vulva due to low estrogen levels, causing it to become dryer which makes it more fragile and easily damaged. Sounds painful right? (The pill can also cause vaginal dryness.) This can be from the decline in estrogen during perimenopause or anything else that can cause a drop in estrogen.

What are some symptoms of VA?

  • Vaginal Dryness
  • A decrease in your natural lubricant during sex
  • Pain during sex, possible light bleeding afterwards
  • Burning, itching while peeing
  • Overactive bladder or urinary incontinence 
  • Shorter vaginal canal- due to lack of sex, more on this later
  • Possibility of frequent UTI’s
  • Discharge 

*Make sure you visit your healthcare practitioner to verify you do have VA/VVA and not something else.

What can you do about VA?

The first recommendation I have seen everywhere in my research is to have frequent sex/sexual activity whether alone or with a partner, as it stimulates blood flow to the area helping it stay supple and healthy. Frequent sexual activity may help the vaginal canal to stay long and wide too. Infrequent sexual activity due to pain and discomfort can make the vaginal canal more narrow and shorter. Ladies, keep having sex to help the terrain of the vulvo-vaginal area. Ensure that you are staying hydrated by drinking half your body weight in ounces of filtered or spring water, not from plastic bottles that can have huge effects on your hormones. Exercise helps with hormonal balance, so find something that works for you whether it’s yoga, HIIT, spin, toning or walking. Natural lubricants can be used during sexual activity. You can look for vaginal moisturizers and lubricants. There is absolutely nothing wrong with using or needing a lubricant. Depending on how you feel about it as it is a very personal decision, you may talk to your healthcare practitioner about trying vaginal estrogen or a natural progesterone cream. Flaxseeds have been shown to help balance estrogen. Supporting your liver so that you can more effectively detox estrogen can help your estrogen/progesterone balance too. Making sure to get enough protein, fat and fiber into your diet at every meal is a must for hormonal balance. It’s all about finding hormonal balance because perimenopause is often a time of of hormonal imbalance based on the decline of estrogen which directly effects how much progesterone is being made.

*I can not give specific recommendations for supplements or dosages unless you are a client of mine and I have done a full health history.

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Harvard Health Publishing. “Managing Postmenopausal Vaginal Atrophy.” Harvard Health,

Montoya, Silvana. “Vaginal Atrophy: Natural Remedies, Causes, and Treatments.” Medical News Today, MediLexicon International, 24 Aug. 2018,

“Vaginal Atrophy Signs, Causes, & Treatment.” Cleveland Clinic,

“Changes in the Vagina and Vulva.” Changes in the Vagina and Vulva, Sexual Side Effects of Menopause | The North American Menopause Society, NAMS,

“Vaginal Atrophy.” Hormone Health Network,

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