What happens to your vagina as you age?

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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.

The Conversation

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  • The Anti-Stress Herb That Also Fights Cancer

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    What does Rhodiola rosea actually do, anyway?

    Rhodiola rosea (henceforth, “rhodiola”) is a flowering herb whose roots have adaptogenic properties.

    In the cold, mountainous regions of Europe and Asia where it grows, it has been used in herbal medicine for centuries to alleviate anxiety, fatigue, and depression.

    What does the science say?

    Well, let’s just say the science is more advanced than the traditional use:

    ❝In addition to its multiplex stress-protective activity, Rhodiola rosea extracts have recently demonstrated its anti-aging, anti-inflammation, immunostimulating, DNA repair and anti-cancer effects in different model systems❞

    ~ Li et al. (2017)

    Nor is how it works a mystery, as the same paper explains:

    ❝Molecular mechanisms of Rhodiola rosea extracts’s action have been studied mainly along with one of its bioactive compounds, salidroside. Both Rhodiola rosea extracts and salidroside have contrasting molecular mechanisms on cancer and normal physiological functions.

    For cancer, Rhodiola rosea extracts and salidroside inhibit the mTOR pathway and reduce angiogenesis through down-regulation of the expression of HIF-1α/HIF-2α.

    For normal physiological functions, Rhodiola rosea extracts and salidroside activate the mTOR pathway, stimulate paracrine function and promote neovascularization by inhibiting PHD3 and stabilizing HIF-1α proteins in skeletal muscles❞

    ~ Ibid.

    And, as for the question of “do the supplements work?”,

    ❝In contrast to many natural compounds, salidroside is water-soluble and highly bioavailable via oral administration❞

    ~ Ibid.

    And as to how good it is:

    ❝Rhodiola rosea extracts and salidroside can impose cellular and systemic benefits similar to the effect of positive lifestyle interventions to normal physiological functions and for anti-cancer❞

    ~ Ibid.

    Source: Rhodiola rosea: anti-stress, anti-aging, and immunostimulating properties for cancer chemoprevention

    But that’s not all…

    We can’t claim this as a research review if we only cite one paper (even if that paper has 144 citations of its own), and besides, it didn’t cover all the benefits yet!

    Let’s first look at the science for the “traditional use” trio of benefits:

    When you read those, what are your first thoughts?

    Please don’t just take our word for things! Reading even just the abstracts (summaries) at the top of papers is a very good habit to get into, if you don’t have time (or easy access) to read the full text.

    Reading the abstracts is also a very good way to know whether to take the time to read the whole paper, or whether it’s better to skip onto a different one.

    • Perhaps you noticed that the paper we cited for anxiety was quite a small study.
      • The fact is, while we found mountains of evidence for rhodiola’s anxiolytic (antianxiety) effects, they were all small and/or animal studies. So we picked a human study and went with it as illustrative.
    • Perhaps you noticed that the paper we cited for fatigue pertained mostly to stress-related fatigue.
      • This, we think, is a feature not a bug. After all, most of us experience fatigue because of the general everything of life, not because we just ran a literal marathon.
    • Perhaps you noticed that the paper we cited for depression said it didn’t work as well as sertraline (a very common pharmaceutical SSRI antidepressant).
      • But, it worked almost as well and it had far fewer adverse effects reported. Bear in mind, the side effects of antidepressants are the reason many people avoid them, or desist in taking them. So rhodiola working almost as well as sertraline for far fewer adverse effects, is quite a big deal!

    Bonus features

    Rhodiola also putatively offers protection against Alzheimer’s disease, Parkinson’s disease, and cerebrovascular disease in general:

    Rosenroot (Rhodiola): Potential Applications in Aging-related Diseases

    It may also be useful in the management of diabetes (types 1 and 2), but studies so far have only been animal studies, and/or in vitro studies. Here are two examples:

    1. Antihyperglycemic action of rhodiola-aqeous extract in type 1 diabetic rats
    2. Evaluation of Rhodiola crenulata and Rhodiola rosea for management of type 2 diabetes and hypertension

    How much to take?

    Dosages have varied a lot in studies. However, 120mg/day seems to cover most bases. It also depends on which of rhodiola’s 140 active compounds a particular benefit depends on, though salidroside and rosavin are the top performers.

    Where to get it?

    As ever, we don’t sell it (or anything else) but here’s an example product on Amazon.

    Enjoy!

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  • Pomegranate vs Cherries – Which is Healthier?

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    Our Verdict

    When comparing pomegranate to cherries, we picked the pomegranate.

    Why?

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  • Beat Cancer Kitchen – by Chris Wark & Micah Wark

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    When we eat, many things can increase our cancer risk. Some we might remember to avoid, like ultra-processed foods and red meat. Others might be more neutral when it comes to cancer, neither good nor bad.

    But! Some foods also have cancer-fighting properties. Which means reducing cancer risk, and/or having an anti-proliferative effect (i.e., shrinks or at least slows growth of tumors), in the event of already having cancer.

    That’s what Chris & Micah Wark are offering here; a cookbook built around anti-cancer foods—after the former beat his own cancer with the help of the latter. He had surgery, but skipped chemo, preferring to look to nutrition to keep cancer-free. Now 18 years later, and so far, so good.

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    • On the other hand, those things if you just purchase them ready-made are usually the things with the most ultra-processed products, thus, having anticancer homemade versions instead here can actually make a very big difference
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    Click here to check out Beat Cancer Kitchen, and take good care of yourself and your loved ones!

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    We’ve previously reviewed “It’s Not You, It’s Your Hormones” by nutritionist Nikki Williams, and noted at the time that it was very similar to the bestselling “The Galveston Diet”, not just in its content but all the way down its formatting. Some Amazon reviewers have even gone so far as to suggest that “It’s Not You, It’s Your Hormones” (2017) brazenly plagiarized “The Galveston Diet” (2023). However, after carefully examining the publication dates, we feel quite confident that the the earlier book did not plagiarize the later one.

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  • Garlic vs Ginger – Which is Healthier?

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