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Managing the Sensitive Symptoms of Menopause

Many menopausal women lose interest in sex but TV doctor, Dawn Harper says it’s possible to bring back the fun between the sheets. In this article she discusses the sensitive symptoms of menopause.

Dr Dawn Harper
Boost your sex drive. Embarrassing Bodies doctor, Dawn Harper stresses the importance of seeking help for menopause related symptoms.

Dr Dawn Harper, the vibrant and delightful medical presenter of the popular Channel 4 show Embarrassing Bodies, understands the complex issues facing menopausal women and their erratic sex drives. A much-loved GP in Gloucestershire, where she lives with her GP husband Graham and three children, Dr Dawn has been fielding questions from troubled patients and viewers for years.

She says the havoc caused to women’s libidos is due to mischievous hormones. “The average age for the menopause in the UK is 50 to 52 when the ovaries stop producing eggs but oestrogen levels can fall anytime from the mid-40s. Hormone levels fluctuate wildly during this time. A lot of women ask for blood tests to check their hormones but readings can vary from day to day.

“As far as I’m concerned, if a woman of a certain age has menopausal symptoms, then it doesn’t really matter what her blood tests say, she needs help! Some women are very sensitive to fluctuating hormones. Post-menopause, the low level of oestrogen has stabilised.”

Lack of oestrogen often leads to vaginal dryness, which makes sex uncomfortable or painful so women avoid sex. “Sex is meant to be fun! Why would you want to have sex if it’s jolly well uncomfortable!” she quips.

You don’t have to just accept it as a normal part of ageing
Dr Dawn recommends oestrogen pessaries or creams to enhance lubrication. “It is so important to see your GP and ask for help. Vaginal dryness shouldn’t be accepted as a normal part of ageing.” Female libido is complicated according to Dr Dawn. Other menopausal symptoms such as night sweats, hot flushes, mood swings, being tearful and suffering low confidence also affect a woman’s interest in sex.

“If you are waking in a drenching sweat several times a night and are chronically sleep deprived, well that’s a good reason for wanting to get to sleep when your head hits the pillow. Weight gain around the midriff, once known as middle-aged spread, can also make a woman feel less attractive and sexy.

“A woman’s interest in sex is affected by a multitude of factors including stresses at work, a messy house and worrying about what the kids are up to! The Empty Nest Syndrome can be a boost to romance but can also bring relationship problems. Women are all very different in how we manage this passage of life.”

Dr Dawn recommends a healthy, well-balanced diet and regular exercise as positive ways to navigate the turbulence of menopause.

What You Need to Know About Uterine Fibroids, and Why

Medical advancements have made uterine fibroids a highly manageable condition. But lack of awareness means that some affected women may be missing out on treatment choices.

Uterine Fibroids

“Fibroids are benign growths that develop in the womb, or uterus. They are very common, affecting 30 to 40 per cent of women in reproductive age and 70 to 80 per cent of those near the menopause,” explains Mr Ertan Saridogan, consultant in gynaecology, reproductive medicine and minimal access surgery at University College London Hospitals (UCLH) and The Portland Hospital, London.

Often Asymptomatic

Typically, symptoms develop only in a relatively small number of affected women. They may include heavy menstrual bleeding, discomfort in the pelvic area, and pressure on the bladder or bowels that increases the need to go to the toilet. Some women may also have difficulties getting pregnant.

Many Treatment Options

Most uterine fibroids don’t need treatment. But this may be necessary if there are symptoms, and should be tailored to individual needs and family plans.

“Options may include medical treatments aimed at relieving symptoms, such as the contraceptive pill or a coil that releases the hormone progesterone into the womb, both of which reduce blood loss due to heavy periods,” says Mr Saridogan.

“If fibroids need to be removed, this can be done through the neck of the uterus and the vagina with a procedure called hysteroscopy. An abdominal operation, or myomectomy, may be needed if the fibroids are large. In this case, the fibroids are removed from the abdomen through either a single large incision, as in traditional open surgery, or multiple small cuts, with a minimally invasive operation called laparoscopic or keyhole surgery. A hysterectomy – the removal of the womb – may be a good option for women who have severe symptoms and are not planning to have children.”

Other, non-surgical options include uterine artery embolization, which involves blocking the blood supply to the fibroids causing them to shrink, and a new technique (high-intensity focused ultrasound) that uses high-energy waves to destroy fibroid tissue.

A novel drug with fibroid-shrinking effects is also available. Called ulipristal acetate, it can be particularly useful for managing symptoms in older women, until they reach the menopause, when fibroids begin to shrink naturally.

Low Awareness

The problem is that, despite uterine fibroids being common, public awareness is generally low.

Mr Saridogan says: “Not all women know about them, and not all medical professionals are aware of the many ways in which they can be managed. Hence, women with the condition may not be told about all the available treatment options.”

Greater awareness can increase the chances of all affected women receiving the most appropriate treatment and enjoying a better quality of life as a result.

We Need to Talk About Incontinence

It can be an awkward subject, but a more open conversation around incontinence is exactly what’s needed to drive real innovation, says specialist Professor Mandy Fader.

Mandy Fadar
Pictured: Mandy Fader, Dean of Health Sciences and Professor of Continence Technology at the University of Southampton

While it is often treatable, incontinence will affect about 1 in 4 of us at some point as a result of a bladder or bowel problem, an operation, conditions such as multiple sclerosis or sometimes for no very clear reason. If incontinence cannot be cured it needs to be managed with pads and devices to enable people to lead a normal life without fear of leakage.

Professor Mandy Fader, Dean of Health Sciences and Professor of Continence Technology at the University of Southampton, says that there is a real need to talk about incontinence and boost creativity among medical manufacturers.

Improving Dignity

“Men are particularly distressed by incontinence,” she says. “Women have periods, child birth, they’re more used to managing and discussing leakage. Men have no experience; they take a stoical attitude and tend to distance themselves from what they perceive as a great indignity. They’ll tell doctors their condition isn’t too bad, but their wives will immediately say, ‘It’s terrible’.

“More open conversation around incontinence is exactly what’s needed.”

“I’d encourage men to be more forthcoming and to have honest discussions with their doctors and nurses. If men realised it’s quite a common condition, and made more of a fuss, there would be even more improvements made within the industry. For example “pads are now made with a super-absorbent gel which reduces odour and stops leakage – the two main fears of discovery,” explains Fader. “Design has improved too: there are now pads specifically for men which cup the penis and scrotum.” Men have other options too such as a penile sheath attached to a leg-bag which can be better for journeys: “For a man it might be unacceptable to have to open their suitcase full of pads at an airport, and a sheath can be a more manly option that can be easier to change.”

Catheters and Coatings

There is positive news for both short- and long-term catheter users. Fader explains that there is now a drive in hospitals to use catheters only when most effective. “As a patient, you may be lying there after an operation feeling you don’t want to get up and go to the loo, but the longer you have the catheter in, the higher your risk of infection.”

There is also lot of research going on into how to avoid bacterial build-up (biofilm) in catheters for long-term users, such as cancer survivors. Biofilm can cause distressing blockages and infections, but “we’re hoping for a breakthrough in the materials used in the coatings,” says Fader.

Choosing a ‘Mix’ of Pads and Devices

It’s important to be aware that all products and devices have strengths and weaknesses and may work better for different people and different activities or times of the day, and that there are plenty of designs which aren’t available in pharmacies but can be found online.

“If more men made a fuss, there would be even more improvements within the industry.”

“Incontinence can be severely disruptive to people’s lives, and that’s where products come in,” says Fader, who suggests visiting www.continenceproductadvisor.org to research options. “We need to see choices, a variety of discreet, effective, reliable options that are comfortable and easy to use, and washable items that avoid waste.”

“We need to make sure that incontinence is treated whenever possible, but for people who have permanent incontinence it needs to be much more socially acceptable,” she insists. “Loads of people have long-term conditions – it’d be good if we got to the point where somewhere like IKEA sells these products and it’s an acceptable part of living.”

Related Article:

How Menopause and Urinary Incontinence are Related

You and Your Skin: Look After it From Within

Leading skincare experts are now advising that treating your skin from the inside-out, by including nutraceuticals in your daily skincare regime, is the best option for you and your skin.

Skin careIt’s important to take a comprehensive approach to your skincare regime; gone are the days of just reaching for the pot of cold cream on your bedside cabinet. Nowadays, in order to do the best for your skin, and achieve the results that you want, it’s important to combine a variety of specialised skincare products and sunscreen, whilst avoiding no-nos like smoking, but also think about treating your skin from within – this means learning about how nutraceuticals can also be used to improve the condition of your skin.

This isn’t just about anti-ageing or wrinkle removal that makes us, as women, feel like there is a clock ticking above our heads which chimes every year and rings out a sound screaming “you’re getting old” – this is about wanting our skin to look great for our age, for others to think we look healthy, well and natural – we want our skin to have vitality! With improved life expectancy, and people much more active than ever before into later life, feeling good also means looking good.

Nutraceuticals and Nutricosmetics

The term ‘nutraceuticals’ was first coined in the late 1980s. It describes the fusion between the words ‘nutrition’ and ‘pharmaceuticals’ as a name for products derived from food sources to promote health, prevent chronic diseases, delay the ageing process or support the structure and function of the body. Honing the definition yet further has seen the concept of ‘nutricosmetics’ appear in recent years – a hybrid between cosmeceuticals and nutraceuticals – which refers to orally taken products, generally derived from natural ingredients, which are aimed at combating oxidative stress and inflammation, caused by our environment and lifestyles, by supplementing nutrients within the body to promote healthy skin. The main products within the nutricosmetics sector are so-called collagen drinks.

We all know that a good diet helps us to have a healthy body, and the skin is no different, there are now dietary supplements available, in the form of collagen-based drinks, which can boost the health of our skin. And in some cases, they have even been shown to have a beneficial effect on hair and nails too, if they also contain a vitamin B complex.

With this in mind, more and more women are becoming aware of the benefits of an inside-out approach to their skincare regime. In fact, a report published by Global Industry Analysts in July 2013 stated that the global nutricosmetics market is forecast to reach $4.24 billion in 2017.

We know women want their skin to look great, we know that more and more are aware of nutraceuticals and nutricosmetics, and that the demand and market for products appears to be growing; but what about the scientific evidence?

Do Collagen Drinks Work?

It’s true to say that not all products are the same, so it’s worth doing some checking. However, more and more nutricosmetics are starting to show positive results from their use in studies and trials – so look for those. Some collagen-based drinks can be bought in high street chemists and some are only available through medical and cosmetic clinics or bespoke online retailers.

They may all contain collagen, but it’s worth checking which source it is derived from, how much of it is contained in the drink, and how large the molecule is as you need it to be small enough to be absorbed into your bloodstream to get to work, rather than being passed out of the body by your digestion if it’s too large, all of these factors will impact on how well a collagen drink works – types include bovine, marine or porcine. The choice is yours, but look for those with enough key active ingredients to do the job that they claim, or if you’re a vegetarian or have religious preferences then be aware of the animal source.

This may just sound like adding a multi-vitamin pill to your daily diet, but the key word here is collagen – this is the main building block of our skin and like any building, as it ages, the bricks get a little more worn and need some repair.

Adding a collagen-based supplement to your diet to assist with the reduction in healthy collagen could be seen as getting the handy-man to come round to repair and rebuild all the broken bricks which you’re not able to do on your own anymore. In fact, you could even go as far as to say that adding a nutraceutical product to your daily skincare routine is an important choice, and probably one that should be given considerable thought.

Evidence from clinical trials is showing a positive effect on skin hydration, the formation of new collagen and improvements in the overall collagen density in the skin following use of collagen-based drinks for 3 months or more – this means that nutricosmetics are re-building the ‘blocks’ to renewed, healthier and more youthful skin.

Knowing Your Boobs Could Save Your Life

Kris Hallenga’s personal experience of breast cancer at 22 inspired her to set up CoppaFeel! the charity reminding us that checking our boobs could be a life saver.

Knowing Your Boobs
Kristin and Maren Hallenga

Many young people think breast cancer cannot afflict them. But Kris Hallenga knows it’s not true.

Kris’s personal story started when, at just 22, she found a lump in her breast. “I went to the doctor and was told it was nothing to worry about,” she says. “Eight months later it was diagnosed as breast cancer. By then it had spread to my spine.”

Radiotherapy, chemotherapy and mastectomy followed, but within a few weeks of diagnosis Kris and her sister Maren founded the charity CoppaFeel! to encourage young people to check their boobs regularly.

Now 29, she says: “We founded CoppaFeel! because no-one was addressing young people about this. We started with a stall at a music festival, talking about boobs. A simple message delivered in a fun way sticks.”

That simple message is: check your boobs and get to know what is normal for you. “One in eight women experiences breast cancer and most cancers are detected through self-checking,” says Kris. “There is no right or wrong way – just do it. If you find anything different go to your GP. Early detection improves outcomes.”

Know the signs and symptoms. CoppaFeel! advises:

  • Look for changes in skin texture (puckering or dimpling), nipple discharge, inversion or changes in direction, swelling in the armpit or round the collarbone, changes in size or shape and rashes or crusting around the nipple or surrounding area.
  • Feel for lumps, thickening, or constant pain in the breast or armpit.

See the instructions at http://coppafeel.org/boob-check/

CoppaFeel! offers a text reminder service that urges people to check regularly and often. Already 23,000 have signed up. The #Breastmates campaign encourages people to remind mates to check their boobs. “My personal Breastmate is Maren, who urged me to return to the doctor with my own lump,” says Kris.

The charity recruits ‘Boobettes’, people 18-35 affected by breast cancer, to give talks to young people. It also runs Festifeel a festival combining music and breast awareness, takes its inflatable ‘Boobcube’ to summer festivals, recruits Uni Boob Team leaders to campaign in universities, and encourages people to take part in events such as marathons, sometimes wearing a giant inflatable boob.

It all sounds fun (and they are looking for more volunteers) but it also saves lives. “Soon after we started I got an email from a girl who was diagnosed early because she read my personal story,” says Kris. “It’s a simple message: check your boobs.”

Tracking Down Osteoporosis – The Silent Disease

A new service that aims to diagnose osteoporosis earlier is now becoming available – and it could save you from painful fractures.

Claire Severgnini
Claire Severgnini, Chief Executive of the National Osteoporosis Society

Over three million people in the UK are estimated to have osteoporosis, but many will not know it.” Osteoporosis is known as ‘the silent disease’ because you may not know you have it until you break a bone,” says Claire Severgnini, chief executive of the National Osteoporosis Society (NOS).

In osteoporosis the struts which make up the mesh-like structure within bones become thin, so bones become fragile and break easily, often following a minor bump or fall. These broken bones are called fragility fractures. The wrists, hips and spine are most commonly affected. Some backache, loss of height and curvature of the spine that can come with age may result from undiagnosed spinal fragility fractures.

Drugs to treat osteoporosis are now available, but many people, unaware they have it, go untreated.

Now NOS is working with the NHS to increase diagnosis by establishing fracture liaison services across the country. Severgnini says: “Over half of people with hip fractures have previously had fragility fractures, so the NHS is reviewing fracture cases and calling in patents for osteoporosis tests where appropriate.”

Currently NOS is working with 142 NHS sites to set up or develop the service, but ultimately it will be available in 170 sites. “This year alone over 2.36 million over-50s have gained access to a fracture liaison service where there was none before,’ says Severgnini. “Over the next five years this is set to prevent 266 hip fractures, avoiding pain for patients and saving the NHS over £4 million.”

You do not have to wait to suffer a fracture to get diagnosed. Gender is a risk factor. One in two women will have osteoporosis after 50 – but so will one in five men.

Over 50s with a family history of osteoporosis or a relative who suffered a fragility fracture are at increased risk. Other risk factors include smoking, alcohol consumption, low weight, poor diet, a history of eating disorders, ethnic background and taking certain medicines.

Early intervention can help stave off osteoporosis. Maximise bone strength from childhood to early adulthood by ‘banking’ plenty of bone in these years, so the skeleton will more easily withstand later bone loss. Take plenty of weight bearing exercise (such as walking) and eat a well balanced, calcium-rich diet. Get plenty of Vitamin D (from sunlight) and avoid faddy diets that reduce calcium or protein.

If you suspect you may be at risk, take an online risk assessment and then see your GP for further assessment, and if applicable, a Bone Density Scan which can confirm a diagnosis.

If diagnosed you will be offered drugs to strengthen your bones. There are always new drugs under development, but any new treatments will not be available for some years.

What about a cure? Severgnini says: “There is none on the horizon now, but current research findings are starting to converge and increase our knowledge, giving us hope of a cure.”

Website: www.nos.org.uk 

Online osteoporosis risk assessment: http://stopatone.nos.org.uk/online-check/

NOS Helpline: 0808 800 0035

Making Strides in the Treatment of Women’s Health

Certain women’s health issues could benefit from recent advances says Dr David Richmond, President of the Royal College of Obstetricians and Gynaecologists.

Making Strides in Womens Health TreatmentThe Royal College of Obstetricians and Gynaecologists (RCOG) will celebrate International Women’s Day (IWD) on 4 March 2016 with the theme ‘Joining up care in maternal mental health’. Expert speakers will provide insights into the challenges experienced in providing effective, joined-up maternal mental health care and we will also hear from women who have experienced maternal mental healthcare problems.

Mental health illness during pregnancy and following delivery are sadly very common with between 12 per cent and 20 per cent of women experiencing anxiety and/or depression during pregnancy and within the first year of childbirth. It is also desperately upsetting that around one quarter of all maternal deaths between six weeks and a year after childbirth are related to mental health problems with one in seven of the women who die in this period committing suicide.

It is therefore vital that women receive the right support and at the right time. Greater integration between primary and secondary care is needed to ensure that women with significant medical and psychiatric conditions are assessed before becoming pregnant and referred to specialist care in a timely manner to ensure that the right support is provided throughout a woman’s pregnancy and beyond. These are themes that will be will also be discussed at the IWD event.

The RCOG has welcomed the news that non-invasive prenatal testing has been recommended for high-risk women on the NHS. This test is the most accurate and safest way of detecting diseases that may have potentially serious consequences, both enhancing the information available to pregnant women and reducing unnecessary invasive procedures. Should the test be rolled out, resources and training for healthcare professionals offering the test will be necessary, in particular around communication and counselling expectant parents about the implications of the test results.

The publication of the NICE menopause guideline at the end of last year was a milestone for both healthcare professionals and women alike. It will help ensure that the best possible care is provided in the diagnosis and treatment of the menopause, a biological stage that every woman experiences to some extent in their lives.


For some women, menopausal symptoms such as hot flushes, night sweats, mood swings and depression as well as a loss of interest in having sex can be extremely debilitating and have a significant impact on a woman’s physical and psychological health, career, social life and relationships. Unfortunately, many women still suffer in silence.

Our hope is that the guideline will not only support healthcare professionals but also provide women with the necessary information to empower them to make informed decisions about their choice of treatment. We also welcome the Chief Medical Officer’s efforts to ensure that employers are also able to offer support and working time flexibility to women through this time. Women feeling able to talk openly to healthcare professionals, their employers, friends and families about their symptoms is key to removing stigma around the menopause.

Fibroids are non-cancerous growths that develop in or around the womb (uterus). They can range in size from larger than a melon to as small as a coin. Around 1 in 3 women of childbearing age have uterine fibroids and while many women do not experience any problems, symptoms can be severe enough to require treatment. In rare cases, further complications caused by fibroids can affect pregnancy or cause infertility.

We strongly encourage women to visit their GP if they have persistent symptoms of fibroids, which can include heavy and prolonged menstrual periods, low back or leg pain, pelvic pain or pressure, pain during sexual intercourse, pressure on the bladder which leads to a constant desire to urinate, pressure on the bowel which can lead to constipation and/or bloating or an enlarged abdomen which may be mistaken for weight gain or pregnancy.

An ultrasound scan is usually able to confirm the diagnosis and medication can help to relieve the symptoms. There are also other medical treatments available to help shrink fibroids. If these prove ineffective, surgical removal or other less invasive procedures may be recommended. Great surgical advances have been made to preserve fertility in the treatment of even the most severe fibroids.

Nowadays there are many complex assisted reproductive technology (ART) options for infertile couples, including gamete/embryo donation, egg/sperm sharing, surrogacy, adoption and fertility preservation. Understanding the current legal and regulatory situation regarding these options, as well as important considerations, such as the welfare of the child or children when surrogacy and adoption are considered, can be overwhelming.

A review published in the The Royal College of Obstetricians & Gynaecologists last year talked about how the psychological impact and private agony of infertility must be carefully considered by healthcare professionals. The review identified infertility as a complex state and life crisis setting out the dangers of neglecting the emotional impact of involuntary childlessness and viewing it solely in biological or medical terms. The authors recommended that counselling practitioners can play a critical role in explaining some or all of the options available to patients and in ensuring that they are well informed before making any treatment choices.

Time to Stop Whispering About Women’s Health

MenopauseIn the past, conversations about gynaecology, childbirth, the menopause, or other problems ‘down there’ – often called “women’s troubles” – would be in hushed tones.

As I trained as a doctor and gynaecologist I found out what really goes on ‘down there’. The knowledge helped me understand how to keep myself healthy and today I want all women to share that knowledge.

Women now talk more openly, but there are still taboos around the menopause, fertility, HRT, and conditions such as breast and ovarian cancer. Too many women still do not have the essential knowledge needed to keep themselves healthy.

This Autumn events will bring women’s health to the fore and make it easier for women to get the information they need.

National Fertility Awareness Week (November 2-8) will provide advice, support and understanding to the one in six couples struggling to become parents (see www.infertilitynetworkuk.com)

After over a decade of confusion and controversy about menopause, and in particular, concern about risks of HRT, November brings new NICE guidelines about the Diagnosis and Management of the Menopause, which are expected to raise awareness of the importance of the menopause and consequences of estrogen deficiency, as well as dispel many myths around treatment options so that women can make truly informed decisions about the management of their menopause.

It’s time to stop whispering. Speak up about women’s health, ask questions and bring the issues into the open so all women benefit.

Why Ovarian Cancer Remains Difficult to Diagnose

At just 30 years old, Fiona Munro has been diagnosed with ovarian cancer. Here she tells about why doctors were so quick to dismiss her symptoms and what you should look out for.

Ovarian Cancer

“Last August I had a ruptured ectopic pregnancy. This led to surgery. After my operation I frequented my GP with complaints of abdominal pain, swelling and the need to pee a lot. She assured me that these symptoms were due to irritation caused by pregnancy but referred me for an ultrasound to reassure me.

The radiologist said I had large cysts on both of my ovaries. She said one looked ‘abnormal’ and perhaps a post-surgery infection was causing my symptoms. I mentioned my family history of ovarian cancer and asked if she thought I should be concerned. She said it was unlikely at my age but that she would refer me to see a consultant gynaecologist and arrange for my GP to take a CA125 blood test to rule it out.

The gynaecologist confirmed that my CA125 blood test results were elevated but he wasn’t concerned because this can also indicate an infection. He asked about sexual partners and said he was going to test me for STIs. I stated that I had been with my husband for 7 years and that I was concerned about ovarian cancer due to my persistent symptoms and family history of the disease.

He told me that he was not concerned and I was not at risk of ovarian cancer.

Over the next few weeks my abdominal swelling reached a point where I was unable to eat and I was growing increasingly anxious about my health.

When I returned to see the gynaecologist he said my tests had come back clear. Despite voicing my concerns again, he insisted I had a post-surgery infection. At a follow-up appointment my CA125 levels had risen even higher. He continued to reassure me that I had a post-surgery infection.

Two weeks later the abdominal swelling and pain got to be too much. I had another ultrasound that showed a build-up of fluid and I was admitted to hospital that night. They drained five litres of fluid from my abdominal cavity.

I was, again, assured that this was a sign of infection, given antibiotics and asked to come in the following week for an MRI. When I came in I was told that the fluid had tested clear from infection and that the lab was conducting further tests.

The further tests confirmed my worst fears. The fluid contained ovarian cancer cells.

After 6 months of appointments, I was diagnosed with Stage 4 ovarian cancer.

What my story shows is that ovarian cancer is a beast to diagnose. But also that we women need to be persistent if they think something’s wrong. Nobody knows your body better than you do – listen to it.”

The symptoms of ovarian cancer are;

• Persistent tummy pain
• Persistent bloating
• Needing to pee more often than usual
• Feeling full very quickly

For more information visit www.ovarian.org.uk. To read more about Fiona’s journey, visit www.fkmunro.com

The Secret Menopause Symptom That Many Women Needlessly Suffer In Silence

Vaginal dryness is the great unspoken menopause symptom, yet a simple, easy treatment could reduce pain, reinvigorate your sex life and enhance your relationship.

Secret Menopause Symptom

Vaginal Dryness is the Secret Symptom of the Menopause.

Gynaecologist Edward Morris, chair of the British Menopause Society (BMS), says: “It’s rarely mentioned in consultations, even though vaginal atrophy, which results in vaginal dryness, affects all women during and after the menopause. Embarrassment, modesty or the mistaken belief that nothing can be done mean many women suffer in silence – yet simple treatmentscan change their lives.”

Vaginal atrophy, the reduction in stretchability and function of the vagina, is caused by falling oestrogen levels. The walls of the vagina get thinner and less elastic and lubrication is reduced, resulting in dryness, higher risk of irritation, reduced resistance to urinary and vaginal infections, and painful intercourse.

“Vaginal dryness can mean that a woman unconsciously associates intercourse with pain, which can reduce her libido and lead to conflict and relationship problems,” says Morris.

There is Treatment Out There

Yet treatment is simple. Prescribed products include vaginal oestrogen creams, or tiny oestrogen tablets that stick to the vaginal walls and deliver a more reliable dose. While both contain enough oestrogen to restore the vagina to its former condition and reduce the risk of infections, a year’s cumulative dosage of the tablets is only the equivalent of one tablet of HRT. Women can use them for as long as they choose. A new orally-taken tablet should be available in the UK soon.

Over-the-counter products such as vaginal moisturisers and sexual Quotelubricants can also help, as can avoiding potential irritants such as perfumed soaps, bath products and vaginal deodorants, and rinsing the vulval area thoroughly. Creams designed to ease irritation may contain preservatives which irritate some women, but swapping to ointments, which have less preservatives, can help, says Morris.