“Many older women were brought up not to talk about their vagina,” Greta said. “They come to see me about something else and then mention they’re worried about something ‘down there’, so I gently help them discuss their symptoms and reassure them that it’s okay to talk about their vaginal health.”

“Menopausal women often experience vaginal dryness and an increase in infections, which can cause odour, pain during sex, bleeding during sex, discharge or an itch,” Greta explained. “In reproductive women, estrogen leads to the production of glycogen, which makes the vagina plump and moist. But in menopausal women, the vaginal tissue becomes more fragile. Thinner and weaker vaginal walls can tear easily, and unwanted microbes can settle into these tears.

“Menopausal women have a more diverse microbiome and a higher pH than women of reproductive age. In peri-menopausal women, thrush can occur more frequently, and in full menopause, bacterial vaginosis and more extreme vaginal infections are more common than in younger women.”

Greta explained the decline in estrogen for women can start from age 35, signalling the start of perimenopause, and it can take ten to 15 years to reach menopause, defined as 12 months without a menstrual period.

“The most important thing for women to understand is that this change is normal, and they have options available to alleviate the uncomfortable symptoms they may experience during perimenopause and menopause,” she said.

“If a woman has vaginal symptoms that concern us, we will use microbiome mapping to check her vaginal health. Often there are easy tweaks menopausal women can make to improve their lives. It all starts by having the courage to chat about your symptoms with a natural health professional.”

“Naturopaths can’t prescribe hormone replacement therapy (HRT),” Greta said. “Women need to see a GP for that, but there are herbs and nutrients that we can prescribe to support you during HRT treatment. There are some great options these days, like applying a topical estrogen gel to the vagina. This kind of preparation doesn't come with the risks of traditional HRT, as it only affects the vaginal tissue and is not circulating in the blood stream. Menopausal women may also benefit from simply using a vaginal moisturiser and a lubricant during sex."

“I also always discuss lifestyle changes that may be causing an imbalance in the vaginal microbiome, such as over-washing, diet or the unintentional misuse of feminine products.”

This blog follows on from an earlier one about the vaginal microbiome in women of reproductive age.