What is estrogen and why is it important for vaginal health?
Estrogen is a steroid hormone that plays a central role in keeping the female reproductive and urinary systems healthy. It is essential for preserving the normal structure and function of the lower genitourinary tract. Estrogen receptors are widely distributed throughout the vagina, vulva, urethra, and bladder trigone, where estrogen supports adequate blood flow, epithelial thickness, tissue elasticity, vaginal rugae, and mucosal hydration.
During the reproductive years, the vaginal epithelium contains abundant glycogen, which is metabolized by resident lactobacilli into lactic acid. This process maintains an acidic vaginal environment (pH 3.5–5.0), promoting the growth of beneficial bacteria and providing protection against vaginal and urinary tract infections. Sexual activity further contributes to vaginal health by stimulating epithelial turnover and improving lubrication.
With menopause, declining estrogen production leads to progressive urogenital atrophy. Reduced estrogen levels result in decreased vaginal secretions, thinning of the epithelium, loss of tissue elasticity, and atrophic changes throughout the genitourinary tract. These changes can lead to symptoms such as vaginal dryness, irritation, discomfort during sex, and urinary problems.
Vaginal dryness is caused by a decrease in estrogen hormones. There are several conditions that lead to reduced estrogen secretion.
The level of estrogen in the blood varies during the monthly menstrual cycle.
For women who are not on hormone-based contraception, estrogen levels drop before and at the end of menstrual bleeding. For this reason, some women experience a certain vulvar and vaginal dryness.
Giving birth, breastfeeding, women with hysterectomy or patients who have had chemotherapy or radiation therapy are also related with a decrease in the amount of estrogen. As a result, vaginal lubrication can be difficult during this period. According to several population studies, more than half of postmenopausal women over the age of 51 suffer from mild or severe vaginal dryness related to specific changes in menopausal hormonal regulation related to decreased estrogen levels.
In addition to hormonal changes, various medical causes are responsible for vaginal dryness. Treatments for high blood pressure, coronary heart disease, antidiabetics, antiallergics, antidepressants, oral contraceptives can affect the amount of vaginal secretion. Also, frequent urinary or vaginal infections disrupt the natural ability to lubricate the vagina.
About 20% of women between the age of 18 and 50 have problems with vaginal lubrication during intercourse, according to the British Society for the Study of Menopause. In most cases, this is caused by insufficient sexual arousal or psychological reasons (stress, fear, depression).
Vaginal dryness before menopause can also be linked with the use of hygiene products that are not suitable for the intimate area or to substances used in disinfecting the swimming pools that can alterate the vaginal flora.
Symptoms of vaginal atrophy are reported by approximately 30% of women in the early postmenopausal period and up to 47% of women in the postmenopausal period.
Major changes caused by hormonal changes in the genital tract translate into:
- Vaginal tissue becomes thinner, drier, less elastic, less lubricated. As a result, injuries and bleeding may occur more easily. Vaginal dryness is identified during a gynaecological examination by observing a decrease in the elasticity of the walls of the vagina or a change in the colour of the tissue.
- The number of vaginal infections increases because the healthy pH of the vagina becomes alkaline from acid.
- Burning sensations during urination and increased urinary tract infections.
- Vaginal dryness causes pain during sexual acts and, over time, women’s refusal to have sex with their partner.
- Emotional changes can appear.
Following national marketing studies, it has been concluded that between 10-40% of women experience vaginal dryness. There has been feedback on the need for an medical device that:
- acts locally, favouring the retention of water inside the vaginal tissue
- dissolves uniformly to act as a vaginal cream and it can be easily cleaned with simple hygiene
- can be used both alone and in combination with other specific products
- it can be used in injuries caused by various interventions (after birth, surgery, radiation)
- it can be used in combination with contraceptive treatment to prevent dryness of the vaginal mucosa.
Vaginal dryness is caused by a decrease in estrogen hormones. There are several conditions that lead to reduced estrogen secretion.
Giving birth and breastfeeding are also moments in a woman’s life when there is a decrease in the amount of estrogen. As a result, vaginal lubrication can be difficult during this period. However, the level of estrogen in the blood varies during the monthly menstrual cycle. For women who are not on hormone-based contraception, estrogen levels drop before and at the end of menstrual bleeding. For this reason, some women experience a certain vulvar and vaginal dryness.
Pre-menopausal women, those who are breastfeeding, those who have had a hysterectomy or cancer patients who have had chemotherapy or radiation therapy may also have low levels of estrogen.
Vaginal dryness is another common symptom of menopause, and nearly one in three women experience this symptom while going through the “menopause changes”. Vaginal dryness becomes even more common in the post-menopausal period.
Regardless of the cause, vaginal dryness can be extremely uncomfortable. Left untreated, it can lead to itching, burning sensation and pain during intercourse.
According to several population studies, more than half of postmenopausal women over the age of 51 suffer from mild or severe vaginal dryness related to specific changes in menopausal hormonal regulation related to decreased estrogen levels. The cessation of ovarian activity results in a decrease in the amount of estrogen and progesterone, and this phenomenon has an impact on the quality of the mucous membranes. Thus, menopausal women may experience symptoms such as: vaginal irritation, even burning sensation.
On the other hand, about 17% of premenopausal women between the ages of 17 and 50 have problems with sexual acts due to vaginal dryness and sexual pain.
Hyaluronic acid maintains adequate levels of hydration, thus promoting tissue elasticity and alleviating vaginal dryness. The clinical studies present in the specialised literature have demonstrated that hyaluronic acid in a concentration of 5 mg has the same effectiveness in treating the genitourinary symptom as a preparation containing 0.625 mg of estrogen.
Hyaluronic acid products are an effective and safe, non-hormonal alternative to local vaginal estrogens and is particularly recommended for women with vaginal dryness who do not want hormone therapy.
Different diseases
such as depression, stress, anxiety, multiple sclerosis, Sjogren’s syndrome.
Medications
like antidiabetic, antihypertensive, contraceptive, anti-estrogen, used to treat uterine fibroids and endometriosis.
Therapies or surgeries
radiation therapy, chemotherapy or ovarectomy.
Birth
immediately after birth and during breastfeeding, women often experience vaginal dryness.
Different diseases
such as depression, stress, anxiety, multiple sclerosis, Sjogren’s syndrome.
Medications
like antidiabetic, antihypertensive, contraceptive, anti-estrogen, used to treat uterine fibroids and endometriosis.
Therapies or surgeries
radiation therapy, chemotherapy or ovarectomy.
Birth
immediately after birth and during breastfeeding, women often experience vaginal dryness.
The use of products with hyaluronic acid is not only an alternative treatment
to vaginal estrogens, but is considered for general
use in women who have vaginal dryness of any cause.
