The Best Moisturizers and Lubricants for Vaginal Menopause Symptoms

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I discuss the first-line management of genitourinary syndrome of menopause (vulvovaginal atrophy).

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Typically starting about four to five years after their last period, about half of postmenopausal women suffer from what we used to call vulvovaginal atrophy, now referred to by the name genitourinary syndrome of menopause (GSM), thanks to the Vulvovaginal Atrophy Terminology Consensus Conference, who needed a more “publicly acceptable term.” After all, the word atrophy had “negative connotations,” and the word vagina “is not a generally accepted term for public discourse.” They liken it to the shift from the “pejorative” impotence to “erectile dysfunction.”

Whatever you call it, it involves changes to the vulva (the external genitalia), the vagina (the birth canal), and bladder, caused by menopausal changes in hormone levels. Vaginal symptoms include vaginal dryness, burning, itchiness and irritation, pain during penetrative sex, and post-coital bleeding from the thinning of the vaginal lining. Urinary symptoms can include recurrent bladder infections and incontinence. Some women with mild GSM remain asymptomatic. For others, symptom severity can preclude intercourse altogether, and result in discomfort even with just sitting or wiping. In a survey of thousands of women with GSM, 59 percent said their symptoms “considerably decreased their enjoyment of sexual activity,” and 23 percent reported it having an adverse effect on their “general enjoyment of life.”

While other menopausal symptoms, like hot flashes, tend to improve over time, GSM symptoms tend to get progressively worse. Unfortunately, women rarely seek medical help, even though there are safe and simple treatments available. The first-line treatment for mild to moderate vaginal dryness are lubricants and moisturizers.

Lubricants are designed to reduce friction during sexual activity, whereas vaginal moisturizers are used on a regular basis (daily or every two to three days as needed) to provide day-to-day comfort by mimicking normal vaginal secretions, regardless of sexual activity. Water-based lubricants have the advantage of being non-staining, and are associated with fewer genital symptoms such as discomfort or burning, compared to silicone-based lubricants.

What’s the best vaginal moisturizer? This head-to-head study pitted vaginal estrogen versus Replens, an expensive vaginal moisturizer claiming special “bioadhesive” ingredients, versus a placebo gel of hydroxyethylcellulose, which is found in products 15 times cheaper, like K-Y Jelly. After 12 weeks, the researchers found no difference between any of them—they all worked the same. This “striking double-negative finding” led to an accompanying commentary in the American Medical Association journal to conclude that until there is evidence to suggest otherwise, “postmenopausal women experiencing vulvovaginal symptoms should choose the cheapest moisturizer or lubricant available over the counter” instead of wasting your money. That was for efficacy, though. What about safety?

The World Health Organization recommends, based on the SMI test, that personal lubricants and vaginal moisturizers not exceed an osmolality of 380. That’s a measure of how concentrated the dissolved components are. How did they come up with that number? By lubing up slugs. SMI stands for slug mucosal irritation. They cover slugs with lubricant over a five-day period and measure how much mucosal irritation and tissue damage the slug experiences. No adverse effects below the 380 cut-off, but something like K-Y Jelly at over 2,000 induced mild to moderate irritation, and something off the charts, like Astroglide at 5,000+, caused severe irritation and tissue damage.

Dozens of commonly-used lubricants and moisturizers available world-wide have been put to the test, and the only two vaginal moisturizers that met the WHO criteria were the Yes brand aloe vera gel-based moisturizer, and the Balance Activ brand hyaluronic acid-based one. The only lubricants that made the cut were those made by brands Yes, Good Clean Love, System Jo, and one product by Durex, their Sensilube gel, but not their Play Feel lubricant.

Please consider volunteering to help out on the site.

Motion graphics by Avo Media

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Typically starting about four to five years after their last period, about half of postmenopausal women suffer from what we used to call vulvovaginal atrophy, now referred to by the name genitourinary syndrome of menopause (GSM), thanks to the Vulvovaginal Atrophy Terminology Consensus Conference, who needed a more “publicly acceptable term.” After all, the word atrophy had “negative connotations,” and the word vagina “is not a generally accepted term for public discourse.” They liken it to the shift from the “pejorative” impotence to “erectile dysfunction.”

Whatever you call it, it involves changes to the vulva (the external genitalia), the vagina (the birth canal), and bladder, caused by menopausal changes in hormone levels. Vaginal symptoms include vaginal dryness, burning, itchiness and irritation, pain during penetrative sex, and post-coital bleeding from the thinning of the vaginal lining. Urinary symptoms can include recurrent bladder infections and incontinence. Some women with mild GSM remain asymptomatic. For others, symptom severity can preclude intercourse altogether, and result in discomfort even with just sitting or wiping. In a survey of thousands of women with GSM, 59 percent said their symptoms “considerably decreased their enjoyment of sexual activity,” and 23 percent reported it having an adverse effect on their “general enjoyment of life.”

While other menopausal symptoms, like hot flashes, tend to improve over time, GSM symptoms tend to get progressively worse. Unfortunately, women rarely seek medical help, even though there are safe and simple treatments available. The first-line treatment for mild to moderate vaginal dryness are lubricants and moisturizers.

Lubricants are designed to reduce friction during sexual activity, whereas vaginal moisturizers are used on a regular basis (daily or every two to three days as needed) to provide day-to-day comfort by mimicking normal vaginal secretions, regardless of sexual activity. Water-based lubricants have the advantage of being non-staining, and are associated with fewer genital symptoms such as discomfort or burning, compared to silicone-based lubricants.

What’s the best vaginal moisturizer? This head-to-head study pitted vaginal estrogen versus Replens, an expensive vaginal moisturizer claiming special “bioadhesive” ingredients, versus a placebo gel of hydroxyethylcellulose, which is found in products 15 times cheaper, like K-Y Jelly. After 12 weeks, the researchers found no difference between any of them—they all worked the same. This “striking double-negative finding” led to an accompanying commentary in the American Medical Association journal to conclude that until there is evidence to suggest otherwise, “postmenopausal women experiencing vulvovaginal symptoms should choose the cheapest moisturizer or lubricant available over the counter” instead of wasting your money. That was for efficacy, though. What about safety?

The World Health Organization recommends, based on the SMI test, that personal lubricants and vaginal moisturizers not exceed an osmolality of 380. That’s a measure of how concentrated the dissolved components are. How did they come up with that number? By lubing up slugs. SMI stands for slug mucosal irritation. They cover slugs with lubricant over a five-day period and measure how much mucosal irritation and tissue damage the slug experiences. No adverse effects below the 380 cut-off, but something like K-Y Jelly at over 2,000 induced mild to moderate irritation, and something off the charts, like Astroglide at 5,000+, caused severe irritation and tissue damage.

Dozens of commonly-used lubricants and moisturizers available world-wide have been put to the test, and the only two vaginal moisturizers that met the WHO criteria were the Yes brand aloe vera gel-based moisturizer, and the Balance Activ brand hyaluronic acid-based one. The only lubricants that made the cut were those made by brands Yes, Good Clean Love, System Jo, and one product by Durex, their Sensilube gel, but not their Play Feel lubricant.

Please consider volunteering to help out on the site.

Motion graphics by Avo Media

Doctor's Note

This is the first video in a three-part series on vaginal menopause symptoms. Stay tuned for Hormone Treatment (Estrogen Pills and Creams) for Vaginal Menopause Symptoms and Soy Milk for Vaginal Menopause Symptoms.

Also see Dietary Approach to Naturally Treating Menopause Symptoms, Menopausal Hot Flashes Are Not Inevitable, Soy Foods for Menopause Hot Flash Symptoms and How to Delay the Age of Menopause with Diet and Lifestyle Factors.

For more on how to live your longest, healthiest life, preorder my new book How Not to Age. (As always, all proceeds I receive from all of my books are donated to charity.)

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