Vaginal dryness is a common symptom in menopause. In fact, it is part of a constellation of symptoms called the “Genitourinary Syndrome of Menopause” (GSM)1. After estrogen levels decline, the vaginal and urinary tract tissues change, often causing women significant problems. However, despite their suffering, many women do not report or seek help for their symptoms.
Vaginal Dryness after Menopause
The authors of a recent review state the “impact of vaginal dryness on interpersonal relationships, quality of life, daily activities, and sexual function can be significant, but is frequently underestimated.”2 It can lead to irritation, pain with intercourse, and sexual dysfunction. In the European REVIVE survey, 70% of postmenopausal women reported vaginal dryness.3
What to Do About Vaginal Dryness
There are many options for treating the symptoms of GSM. The standard therapy is local estrogen replacement, but some women may not want or feel comfortable with this option. Also, for women with a personal or family history of estrogen-sensitive cancers, estrogen replacement might not be a good option. Therefore, other treatments are needed! The first-line treatment for vaginal dryness includes moisturizers and lubricants because they can give significant relief from vaginal irritation and pain with sex.
Vitamin E: Effective for Vaginal Dryness – the Research
Vitamin E is a fat-soluble vitamin with antioxidant properties. It helps to prevent oxide/peroxide damage to cell membranes. Vitamin E also helps to stabilize estrogen levels and has been studied for the treatment of a variety of menopausal symptoms like hot flashes, irritability, and of course, vaginal dryness.4
A study from Italy in 2008 looked at a suppository containing hyaluronic acid, vitamin E, and vitamin A for its ability to reduce symptoms related to vaginal dryness.5 The subjects used one suppository per day for 14 days. For the next two weeks, they used one suppository every other day. The results were that the symptoms due to vaginal dryness had resolved by 50% at the end of the first week. The symptoms were completely resolved by the end of the study. There were no adverse effects of the treatment. A weakness of this trial was that it was not randomized, blinded, or controlled. The reason the study design did not include placebo was that materials used for a placebo suppository could confound the results by causing changes in pH and local epithelial alterations. The suppository in this study clearly contained more than vitamin E, so it is hard to say what role vitamin E played, but the results are promising.
A randomized controlled study from Iran in 2010-2011 compared a 1 mg vitamin E suppository to placebo – a semi-synthetic fatty acid triglyceride.4 The intervention lasted 8 weeks. Primary endpoints included a review of symptoms of vaginal atrophy, vaginal pH, and the mean vaginal maturation index (VMI – a ratio of the different types of epithelial cells present in the vaginal mucosa). The results showed that the vitamin E group had significantly reduced vaginal symptoms, a reduction in vaginal pH, and an increase in the VMI. A reduced pH creates a less hospitable environment for pathogenic bacteria. The increase in VMI indicates a thickening in the vaginal mucosa, meaning it will be less fragile and more resilient.
Another randomized, controlled study from Iran in 2016 compared a 100IU vitamin E suppository to 0.625 mg of conjugated estrogen cream for 12 weeks. They defined treatment success as a 10 unit increase on the VMI.6 They measured the VMI at baseline, 4, 8, and 12 weeks. At 4 weeks, both treatment arms met the criteria for treatment success by having a >10 unit increase in VMI, but the estrogen group was significantly higher. However, the VMI continued to rise in the vitamin E group, narrowing the gap in treatment efficacy by week 12.
This is not a complete review of all the studies of local vitamin E treatment for vaginal dryness. Although it does not appear to equal conjugated estrogen for managing the GSM symptom of vaginal dryness, it has been shown to offer significant relief. It is not just managing a symptom, but it also appears to improve vaginal tissue integrity and the environment. All these studies were relatively short-term. Considering the excellent safety profile, vitamin E suppositories could be an effective way to manage GSM long-term.
This article is meant to be educational. Please consult your doctor for medical advice on how to manage the genitourinary symptoms of menopause.
REFERENCES:
1. Kim H-K, Kang S-Y, Chung Y-J, Kim J-H, Kim M-R. The Recent Review of the Genitourinary Syndrome of Menopause. J Menopausal Med. 2015;21(2):65. doi:10.6118/jmm.2015.21.2.65
2. Edwards D, Panay N. Treating vulvovaginal atrophy/genitourinary syndrome of menopause: How important is vaginal lubricant and moisturizer composition? Climacteric. 2016;19(2):151-161. doi:10.3109/13697137.2015.1124259
3. Nappi RE, Palacios S, Panay N, Particco M, Krychman ML. Vulvar and vaginal atrophy in four European countries : evidence from the European REVIVE Survey. 2016;19(2):188-197.
4. Ziagham S. Effect of vitamin E vaginal suppository on atrophic vaginitis among postmenopausal women. Jundishapur J Chronic Dis Care. 2013;2(March):11-19.
5. Costantino D, Guaraldi C. Effectiveness and safety of vaginal suppositories for the treatment of the vaginal atrophy in postmenopausal women: An open, non-controlled clinical trial. Eur Rev Med Pharmacol Sci. 2008;12(6):411-416.
6. Emamverdikhan A, Golmakani N, Tabassi S, Hassanzadeh M, Sharifi N, Shakeri M. A survey of the therapeutic effects of Vitamin E suppositories on vaginal atrophy in postmenopausal women. Iran J Nurs Midwifery Res. 2016;21(5):475. doi:10.4103/1735-9066.193393
