Vaginal dryness and vaginal atrophy are conditions that are commonly associated with menopause, but many new moms experience these conditions as well. Otherwise known as Lactational Atrophic Vaginitis, breastfeeding mothers have decreased estrogen levels which can cause urogenital atrophy which includes epithelial thinning, decreased elasticity and diminished blood flow to the genitalia.
Symptoms may be as follows:
- Vaginal dryness
- Dyspareunia (painful sexual intercourse)
An internal examination is important to assess for:
- Shrinking and dryness of the labia and vaginal tissues
- Inflammation and erythema of the vulva
- Decreased vaginal and cervical secretions
- Thin, pale vaginal tissues
- Friability from fragility of the vaginal mucosa
The first line of defense that HCPs (like your midwife or obstetrician) should use are personal moisturizers. This should be the first line measure only as lubricants are more of a band-aid solution and do not address the issue that is causing the symptoms. Furthermore, it is important to note that midwives are now able to prescribe low dose localized estrogen therapy in the postpartum period.
There are a number of vaginal moisturizers that are hormone-free that come in the form of a gel, cream, and ovule. I often recommend RepaGyn which is an ovule that consists of hyaluronic acid, vitamin E and tea tree oil. It is used nightly for one week and then twice weekly until breastfeeding is complete. It is available at the pharmacy counter so a woman does not need a prescription.
If a breastfeeding mother does require a vaginal estrogen cream, she can still use estrogen-free RepaGyn in the postpartum period. Some women are uncomfortable with using estrogen creams because one of them is isolated from pregnant mares urine.
Many women wonder when is the most effective time to use vaginal estrogen creams? The answer is usually around 8 – 12 weeks postpartum after the significant drop in estrogen has had time to contribute to vaginal atrophy.
Localized estrogens are generally considered to be safe to use, but theoretically, may cross over into the systemic blood system and decrease a mother's milk supply. This is one good reason that personal moisturizers are a good first line treatment. Estrogen cream should not be used prior to 6 weeks postpartum.
The benefit must outweigh the risk in terms of any medical treatment, but especially in the early days of life.