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How to Treat Vaginal Itching in Perimenopause

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Vaginal itching is a very real problem that can start during perimenopause and gradually worsen with time. While you may be tempted to reach for an anti-itch cream or yeast infection treatment, the appropriate treatment for perimenopause-related vaginal itching is prescription vaginal estrogen.

What causes vaginal itching?

There are several common causes of vaginal itching:

  • Bacterial vaginosis: This common vaginal infection produces a vaginal discharge that has a fishy odor and that can be irritating to the skin. Bacterial vaginosis (BV) infections are treated with BV antibiotics.
  • Yeast infections: This common vaginal infection is associated with vaginal itching and an odorless and cheesy discharge. Yeast infections are treated with OTC creams or prescription antifungals like fluconazole.
  • Hormonal changes like perimenopause, menopause, and breastfeeding: Dips in estrogen can lead to lack of moisture and lubrication in the vagina and vulva. Loss of estrogen in the vaginal area is treated with prescription vaginal estrogen therapy, and can be lessened by vaginal moisturizers.
  • Other less common causes: Bacterial infections like chlamydia and gonorrhea, sexually transmitted infections like genital herpes, and inflammatory skin conditions like vulvar lichen sclerosis and vulvar lichen planus.

What causes vaginal itching during perimenopause?

Estrogen levels fluctuate wildly during perimenopause. These dips in estrogen can affect the vagina, vulva, bladder, and urinary tract.

Vaginal atrophy (VA) or the genitourinary syndrome of menopause (GSM) is the medical term that describes hormonal changes that manifest as vaginal and urinary symptoms, including vaginal itching.

GSM is a common condition that affects up to 85% of post-menopausal women. Symptoms can start in your 30s and 40s during the perimenopause years, and usually will get worse with time.

How to treat vaginal itching during perimenopause

Before prescribing treatment, your medical provider may evaluate the potential for an infection or inflammatory skin disorder which can trigger vaginal itching.

If there is no infection or inflammatory skin disorder, your medical provider may suggest a vaginal moisturizer. Ingredients like hyaluronic acid, for example, are not only helpful for dry skin on the face, they can also help with dryness and itching in the vaginal area. However, most of the time the skin can be so itchy and so dry that moisturizers will not adequately solve the problem.

When vaginal itching happens during perimenopause, your medical provider may suggest topical vaginal estrogen treatment. Vaginal estrogen can be offered as an estradiol vaginal cream or estradiol vaginal suppository. This topical treatment contains a very low dose of estrogen, which helps restore moisture to the skin in and around the vagina.

When using vaginal estrogen therapy, the healing process for the skin can take about 2-4 weeks. After that, vaginal estrogen treatments are usually applied twice a week to prevent vaginal dryness and itching. It can also stave off complications from perimenopause and menopause - including painful sex, unusual odor, elevated vaginal pH, UTIs, and incontinence.

You can't get vaginal estrogen over-the-counter, so you'll need a prescription. But we make that part super easy with an online consult and free shipping.

Are there home remedies for vaginal itching?

Home remedies like coconut oil can be used in a pinch in order to alleviate vaginal itching, but use these remedies with caution. Using coconut oil in the vagina can make the vaginal pH higher , disrupting the delicate balance of the vaginal microbiome and potentially leading to yeast infections or bacterial vaginosis. So, it’s best to avoid using coconut oil if you’re prone to these kinds of infections.

It’s important to use mild soap products, avoid douching, and look for a good vaginal moisturizer to prevent skin irritation.

The key takeaways

  • Vaginal itching is usually caused by bacterial infections, inflammatory skin conditions, and hormonal changes.
  • Perimenopause causes drops in estrogen, which can lead to vaginal itching.
  • Complications from untreated hormonal changes can include painful sex, unusual vaginal odor, elevated pH, UTIs, and incontinence.
  • Perimenopause-related vaginal itching is best treated by a licensed medical doctor who can offer topical treatments like prescription vaginal estrogen cream.