Managing Menopausal Vulva Skin Changes

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What is Menopause?

Menopause is a natural occurrence at the end of women’s sexual reproductive years, just as the first period during puberty was the start.

The term menopause is often used incorrectly. According to the International Menopause Society (IMS);

  • Menopause is the last day of a woman’s last period ever
  • Perimenopause is the time before, around and just after the actual moment of menopause
  • Postmenopause is the stage after the final menstrual period.

You will know that menopause has taken place if you have not had any menstrual bleeding for 12 months. Most women reach menopause between the ages of 45 and 55, the average being around 51.

During perimenopause, the most physical changes occur; periods become irregular and hot flushes and night sweats may start. During this stage one may still be fertile and conceive although the chances of pregnancy are often negligible. Perimenopause is the time during which ovarian hormones start to change and egg production is significantly reduced.

What causes menopause?

Menopause is caused by reduced secretion of the ovarian hormones Oestrogen and Progesterone.

Oestrogen is the principal female sex hormone produced by the ovaries and is vital for the growth of eggs and for the reproductive process. It also plays a role throughout the body in maintaining cardiovascular, brain and bone health, along with many other tissues in the body.
Progesterone is another female hormone produced by the ovaries. One of its many functions is to help to maintain pregnancy. It is secreted during the second half of the menstrual cycle and signals to the uterus that an egg has been released.
Hormonal fluctuations leading to menopause may change ones menstrual cycle such as:

  • Period cycles may become longer, shorter, or totally irregular
  • Bleeding may become lighter
  • Bleeding may become unpredictable and heavy

Eventually, hormone levels will fall to a point where ovaries stop releasing eggs, periods stop and menopause is reached. Although menopause is a normal event for women, individual experiences vary.

Menopause symptoms

Some of the symptoms women may have include:

  • Hot flushes
  • Night sweats
  • Aches and pains
  • Crawling or itching sensations under the Skin
  • Forgetfulness
  • Headaches
  • Irritability
  • Lack of self-esteem
  • Reduced sex drive (libido)
  • Tiredness
  • Difficulty sleeping
  • Urinary frequency
  • Vaginal dryness
  • Discomfort with sexual intercourse

Managing menopause symptoms

Unpleasant symptoms of menopause can often be reduced by the below lifestyle changes:

  • Healthy diet
  • Regular exercise
  • Looking after your mental health
  • Reducing your stress levels
  • Getting enough good quality sleep
  • Using light-weight sleepwear and bedding to help with night sweats
  • Avoiding the things that trigger your hot flushes
  • Quitting smoking

Hormone replacement therapy (HRT) can also help reduce these symptoms however, while HRT can be effective for many individuals, it is important to be aware of potential side effects. The specific side effects can vary depending on the type of HRT, the dosage, and individual factors. The treatment should be under the supervision of your medical practitioner to minimise the risks and side effects.

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Skin changes with menopause

Menopause is a time of significant and rapid Skin changes. It induces cosmetic and structural changes to the Skin due to rapid decline in oestrogen production causing the Skin to age more rapidly. Oestrogen can increase Skin collagen content (one of the main structural proteins within Skin), oil production and water retention to support Skin thickness, elasticity and hydration.
Decreased oestrogen impairs the production of glycosaminoglycans in the dermal layer of Skin, which over time reduces collagen production and the water content of the Skin. According to the American Academy of Dermatology, studies show that women’s Skin loses about 30% of its collagen during the first 5 years after menopause. After that, the decline is more gradual. Women lose about 2% of their collagen every year for the next 20 years.
Degradation of elastic fibres in the dermal layer are also associated with decreased oestrogen production resulting in thinning of the epidermal layer.

The Skin changes associated with menopause include:

  • Increased dryness
  • Increased sensitivity
  • Decreased Skin firmness and elasticity
  • Thinner and more prone to damage and bruising
  • More fine lines and wrinkles
  • Longer healing
  • Acne and breakouts

Vulva Skin changes with menopause

Vulva Skin goes through the above mentioned changes just like Skin in other parts of the body. Additionally, Vulvovaginal changes that happen perimenopause, can leave this area vulnerable to various complications.

Less oestrogen may cause the vulva tissue to become thinner, drier, and less elastic. Vaginal secretions are reduced, resulting in decreased lubrication. Reduced levels of oestrogen also result in an increase in vaginal pH, which makes the vagina less acidic and more at risk of infections.

Many women experience vulva symptoms perimenopause and postmenopause that include:

  • Dryness
  • Sensitivity
  • Itching
  • Irritation
  • Inflammation
  • Redness
  • Burning
  • Bleeding
  • Malodorous discharge
  • Chafing
  • Acne

Unlike some menopausal symptoms, such as hot flushes, which may disappear as time passes; Vulvovaginal problems often persist and may progress with time.

Like Hormone replacement therapy (HRT), topical oestrogen can help minimise these symptoms however, it’s important to note that the benefits and risks of such treatments can vary depending on the individual’s medical history, age, and other factors. Consulting with your healthcare professional is essential to discuss your specific situation to make an informed decision.

Whether or not you choose to try hormonal treatments, there are ways to topically reduce vulva discomfort caused by menopause.

Managing menopausal symptoms on vulva Skin

Eliminating any aggravating factors should be the first step to reduce vulva discomfort. Menopausal women are more likely to be affected by these factors than younger women, as the vulva Skin lipid barrier is more vulnerable due to oestrogen deficiency.

What to avoid when caring for vulva Skin;

  • Avoid scratching and rubbing as this will further inflame the compromised Skin. Keeping fingernails short can lower the risk of Skin insults.
  • Avoid exposure to urine or faeces which will cause irritation and increase the risk of infections
  • Ensure pads or underwear designed for incontinence are used rather than pads intended for menstrual use. If leakage occurs, ideally the urine should be rinsed off the vulva with water followed by the application of an intimate barrier cream.
  • Wear comfortable underwear and avoid pantyhose. Avoid wearing underwear at night unless specific incontinence products are required.
  • Limit the amount of time your Skin is exposed to water. Prolonged exposure to hot water can dehydrate the Skin tissue. A long hot bath combined with the use of bubble bath and salts is a recipe for failure.
  • Use white, unscented soft toilet paper. Some of the inks on the printed papers can irritate Skin.
  • Avoid using douches as they can cause irritation and may alter normal desirable vaginal microbiome which in turn will change the vulva microbiome
  • Avoid using products containing aggressive preservatives (such as methylisothiazolinone) to which contact allergy is increasingly reported.
  • Avoid the use of soaps. Soap generally dries the Skin by stripping away natural oils. Extreme dryness can also contribute to itchiness, irritation and burning sensations. Soap also has an alkaline pH which can increase the pH of the vulva Skin and increase the risk of infections.
  • Avoid harsh cleansing products such as sulfates. Such surfactants, similar to soap, dry the Skin by stripping away natural oils.
  • Avoid perfumed products. Scented products including fragrances and essential oils may include 26 fragrance allergens according to The International Fragrance Association (IFRA). This can increase the risk of topical allergic reactions.

What to include in your vulva skincare routine;

The Skin in the vulva area is delicate, even more so during perimenopause and postmenopause. As a rule of thumb, any product used on vulva Skin should be specifically designed for this sensitive area. Ingredients used in the product should be gentle to avoid disturbing the natural balance.

Even if you have never had any topical allergic reactions before, you may develop an allergy at any point in life to the fragrances you’ve used for a long time hence fragrance-free should be the first deciding factor.

The pH of the product is particularly important (should be acidic around 4.50) to avoid altering vulval microbiome, compromising the lipid barrier and increased risk of infections.

A well balanced vulva skincare routine will look like the following;

  • Wash with a gentle intimate cleanser and lukewarm water. The type of cleanser used is crucial in any skincare routine, if not chosen carefully it can exacerbate the existing condition. Cleansers containing mild cleansing agents will avoid striping away natural oils and consecutive driness.
  • Hydrate at least once a day. This area is prone to dryness, especially in postmenopausal women which in turn can cause secondary issues such as sensitivity, itching, and redness. Reduced oil production due to Oestrogen decline means weaker lipid barrier which will increase Transepidermal water loss (TEWL). Hydrating the Skin topically will compensate for the water lost due to higher TEWL rates. Look for humectants and electrolytes particularly those that naturally occur within Skin and are referred to as Natural Moisturising factors (NMF). Hyaluronic Acid, Sodium PCA, Lactic Acid and Sodium Lactate are a few examples.
  • Moisturise at least once a day. While hydrating can put back the lost water from the surface, moisturising will seal the water in. Moisturisers that can repair compromised Skin lipid barrier will dramatically reduce Transepidermal water loss (TEWL) and increase Skin’s water content overtime. Look for emollients particularly those that naturally occur within Skin and are referred to as Natural Moisturising factors (NMF). Ceramides, free fatty acids, phytosphingosine and Squalane are a few examples.
  • Due to hormonal fluctuations, acne is also another concern for menopausal Skin so it’s important to choose non-pore clogging, non-comedogenic moisturisers to reduce the risk of acne and breakouts. If acne is also a concern, including a gentle exfoliating serum in your routine followed by a non-comedogenic moisturiser can help manage breakouts.
  • Choose products with soothing and anti-inflammatory properties. Intimate care products containing anti-inflammatory ingredients can help to reduce inflammation and irritation in the vulva area. Prebiotics, Allantoin, Niacinamide, Panthenol and Bisabolol are examples of this group of ingredients.

The bottom line is, although we can not stop or reverse the natural Skin ageing process or the menopausal symptoms, consistent care for the vulva Skin can help manage the discomfort in the vulva Skin.

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