The vagina is an internal organ with a complex ecosystem, influenced by circulating hormone levels which change during the menstrual cycle, pregnancy, breastfeeding and menopause.

Around and after menopause, there are normal changes in the growth and function of vaginal cells, as well as the vagina’s microbiome (groups of bacteria living in the vagina). Many women won’t notice these changes. They don’t usually cause symptoms or concern, but if they do, symptoms can usually be managed.

Here’s what happens to your vagina as you age, whether you notice or not.

Let’s clear up the terminology

We’re focusing on the vagina, the muscular tube that goes from the external genitalia (the vulva), past the cervix, to the womb (uterus). Sometimes the word “vagina” is used to include the external genitalia. However, these are different organs and play different roles in women’s health.

What happens to the vagina as you age?

Like many other organs in the body, the vagina is sensitive to female sex steroid hormones (hormones) that change around puberty, pregnancy and menopause.

Menopause is associated with a drop in circulating oestrogen concentrations and the hormone progesterone is no longer produced. The changes in hormones affect the vagina and its ecosystem. Effects may include:

• less vaginal secretions, potentially leading to dryness
• less growth of vagina surface cells resulting in a thinned lining
• alteration to the support structure (connective tissue) around the vagina leading to less elasticity and more narrowing
• fewer blood vessels around the vagina, which may explain less blood flow after menopause
• a shift in the type and balance of bacteria, which can change vaginal acidity, from more acidic to more alkaline.

What symptoms can I expect?

Many women do not notice any bothersome vaginal changes as they age. There’s also little evidence many of these changes cause vaginal symptoms. For example, there is no direct evidence these changes cause vaginal infection or bleeding in menopausal women.

Some women notice vaginal dryness after menopause, which may be linked to less vaginal secretions. This may lead to pain and discomfort during sex. But it’s not clear how much of this dryness is due to menopause, as younger women also commonly report it. In one study, 47% of sexually active postmenopausal women reported vaginal dryness, as did around 20% of premenopausal women.

Other organs close to the vagina, such as the bladder and urethra, are also affected by the change in hormone levels after menopause. Some women experience recurrent urinary tract infections, which may cause pain (including pain to the side of the body) and irritation. So their symptoms are in fact not coming from the vagina itself but relate to changes in the urinary tract.

Not everyone has the same experience

Women vary in whether they notice vaginal changes and whether they are bothered by these to the same extent. For example, women with vaginal dryness who are not sexually active may not notice the change in vaginal secretions after menopause. However, some women notice severe dryness that affects their daily function and activities.

In fact, researchers globally are taking more notice of women’s experiences of menopause to inform future research. This includes prioritising symptoms that matter to women the most, such as vaginal dryness, discomfort, irritation and pain during sex.

If symptoms bother you

Symptoms such as dryness, irritation, or pain during sex can usually be effectively managed. Lubricants may reduce pain during sex. Vaginal moisturisers may reduce dryness. Both are available over-the-counter at your local pharmacy.

While there are many small clinical trials of individual products, these studies lack the power to demonstrate if they are really effective in improving vaginal symptoms.

In contrast, there is robust evidence that vaginal oestrogen is effective in treating vaginal dryness and reducing pain during sex. It also reduces your chance of recurrent urinary tract infections. You can talk to your doctor about a prescription.

Vaginal oestrogen is usually inserted using an applicator, two to three times a week. Very little is absorbed into the blood stream, it is generally safe but longer-term trials are required to confirm safety in long-term use beyond a year.

Women with a history of breast cancer should see their oncologist to discuss using oestrogen as it may not be suitable for them.

Are there other treatments?

New treatments for vaginal dryness are under investigation. One avenue relates to our growing understanding of how the vaginal microbiome adapts and modifies around changes in circulating and local concentrations of hormones.

For example, a small number of reports show that combining vaginal probiotics with low-dose vaginal oestrogen can improve vaginal symptoms. But more evidence is needed before this is recommended.

Where to from here?

The normal ageing process, as well as menopause, both affect the vagina as we age.

Most women do not have troublesome vaginal symptoms during and after menopause, but for some, these may cause discomfort or distress.

While hormonal treatments such as vaginal oestrogen are available, there is a pressing need for more non-hormonal treatments.

Dr Sianan Healy, from Women’s Health Victoria, contributed to this article.

Louie Ye, Clinical Fellow, Department of Obstetrics and Gynecology, The University of Melbourne and Martha Hickey, Professor of Obstetrics and Gynaecology, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

You wake up, stagger to the bathroom and gaze into the mirror. No, you’re not imagining it. You’ve developed face wrinkles overnight. They’re sleep wrinkles.

Sleep wrinkles are temporary. But as your skin loses its elasticity as you age, they can set in.

Here’s what you can do to minimise the chance of them forming in the first place.

How side-sleeping affects your face

Your skin wrinkles for a number of reasons, including ageing, sun damage, smoking, poor hydration, habitual facial expressions (such as grinning, pouting, frowning, squinting) and sleeping positions.

When you sleep on your side or stomach, your face skin is squeezed and crushed a lot more than if you sleep on your back. When you sleep on your side or stomach, gravity presses your face against the pillow. Your face skin is distorted as your skin is stretched, compressed and pulled in all directions as you move about in your sleep.

You can reduce these external forces acting on the face by sleeping on your back or changing positions frequently.

Doctors can tell which side you sleep on by looking at your face

In a young face, sleep wrinkles are transient and disappear after waking.

Temporary sleep wrinkles can become persistent with time and repetition. As we age, our skin loses elasticity (recoil) and extensibility (stretch), creating ideal conditions for sleep wrinkles or lines to set in and last longer.

The time spent in each sleeping position, the magnitude of external forces applied to each area of the face, as well as the surface area of contact with the pillow surface, also affects the pattern and rate of sleep wrinkle formation.

Skin specialists can often recognise this. People who favour sleeping on one side of their body tend to have a flatter face on their sleeping side and more visible sleep lines.

Can a night skincare routine avoid sleep wrinkles?

Collagen and elastin are two primary components of the dermis (inner layer) of skin. They form the skin structure and maintain the elasticity of skin.

Supplementing collagen through skincare routines to enhance skin elasticity can help reduce wrinkle formation.

Hyaluronic acid is a naturally occurring molecule in human bodies. It holds our skin’s collagen and elastin in a proper configuration, stimulates the production of collagen and adds hydration, which can help slow down wrinkle formation. Hyaluronic acid is one of the most common active ingredients in skincare creams, gels and lotions.

Moisturisers can hydrate the skin in different ways. “Occlusive” substances produce a thin layer of oil on the skin that prevents water loss due to evaporation. “Humectants” attract and hold water in the skin, and they can differ in their capacity to bind with water, which influences the degree of skin hydration.

Do silk pillowcases actually make a difference?

Silk pillowcases can make a difference in wrinkle formation, if they let your skin glide and move, rather than adding friction and pressure on a single spot. If you can, use silk sheets and silk pillows.

Studies have also shown pillows designed to reduce mechanical stress during sleep can prevent skin deformations. Such a pillow could be useful in slowing down and preventing the formation of certain facial wrinkles.

Sleeping on your back can reduce the risk of sleep lines, as can a nighttime routine of moisturising before sleep.

Otherwise, lifestyle choices and habits, such quitting smoking, drinking plenty of water, a healthy diet (eating enough vegetables, fruits, nuts, seeds, healthy fats, yogurt and other fermented foods) and regular use of sunscreens can help improve the appearance of the skin on our face.

Yousuf Mohammed, Dermatology researcher, The University of Queensland; Khanh Phan, Postdoctoral Research Fellow, Frazer Institute, The University of Queensland, and Vania Rodrigues Leite E. Silva, Honorary Associate Professor, Frazer Institute, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.