When The New York Times and National Geographic cover the subject of menopause in the same calendar year, perhaps it’s a sign that the inevitable phase of a woman’s life that ushers in vaginal dryness, irregular periods, hot flashes, brain fog, mood swings, night sweats, sleep problems, decreased sex drive and weight gain is finally getting the attention it deserves.

Solutions for women experiencing perimenopause, menopause and post-menopause are not covered in medical school. Instead, they stem from the work of pioneers like Dr. Pamela Wartian Smith, author of What You Must Know About Women's Hormones: Your Guide to Natural Hormone Treatments for PMS, Menopause, Osteoporosis, PCOS, and More, and Dr. Christiane Northrup, who wrote Women's Bodies, Women's Wisdom: Creating Physical and Emotional Health and Healing.

Today, integrative and functional doctors, researchers and continuing education instructors are leading the charge to provide innovative and customized answers for women experiencing vaginal dryness and other hormone-related symptoms. 

The earliest sign of changes occurs between the ages of 40 to 44, during perimenopause, and according to Dr. Lindsey Berkson, author of Safe Hormones, Smart Women, vaginal dryness is the flashing red light. “A sign of insufficient hormone signaling, vaginal dryness is the body’s warning that bones are beginning to thin; the brain’s structure, activity and neuron connectivity are beginning to decline; and the aging process has begun,” she explains. 

A continuing education instructor for doctors and pharmacists, Berkson notes, “The vagina doesn’t exist alone. Treating only the vagina is minimized medicine. It’s so important to find a doctor who practices functional medicine, has completed continuing education hours in hormone replacement therapy and nutrition, and has experience in these areas.”

Dr. Meena Malhotra, a double board-certified internist practicing functional and integrative medicine for 27 years, understands that vaginal tissue is hormone-dependent, and dryness left untreated can lead to urinary tract infections that can progress to kidney infections. “Atrophic vaginitis with dryness, itching and burning doesn’t happen overnight; it happens gradually. Many women who are not seeing a gynecologist regularly for checkups are unaware of the gradual decrease of their progesterone and estrogen,” advises the founder of the Heal n Cure Medical Wellness Center, in Glenview, Illinois. 

“Women generally self-treat sexual discomfort from dryness first with self-prescribed, over-the-counter gels, suppositories and creams, which are temporary fixes,” Malhotra says. “Functional medicine, which allows for longer appointments, in-depth intake and more intimate conversations, can determine the root cause of vaginal dryness, which can be treated early with FormaV, a non-surgical, painless rejuvenation procedure which tightens loose labia, improves vaginal health and makes sexual intimacy desirable again.”

Known as “the girlfriend doctor”, triple board-certified obstetrician and gynecologist Anna Cabeca has been in practice for 23 years and is the author of The Hormone Fix: Burn Fat Naturally, Boost Energy, Sleep Better, and Stop Hot Flashes, the Keto-Green Way. Recognizing that many over-the-counter lubricants perpetuate dryness and create damage to the tissue, she formulated her own products. “Inflammation can happen because of a reaction to the ingredients in the lubricant. I tell my patients that they can make their own lubricant using organic coconut oil mixed with aloe vera gel and a few drops of an essential oil that turns their partner on. They can also strengthen the pelvic floor with Kegel exercises and eat a keto-green diet,” Cabeca suggests.

Dr. Rebecca Hunton, the founder of Radiantly Healthy MD, in Melbourne, Florida, believes that treating the changes in a woman’s body is a form of personalized medicine. “Every woman’s journey is different, but generally before vaginal dryness comes progesterone deficiency. Symptoms include trouble falling asleep, anxiousness and moodiness,” she says, adding that not all vaginal dryness is hormone-related, as an autoimmune disorder could also be a cause. 

Hunton recommends, “Starting early with a transdermal progesterone cream can mitigate some dryness, but at a certain point, progesterone won't suffice. There are nonsurgical treatments such as MonaLisa Touch, a laser treatment that brings the tissue in the vagina to a more youthful state. It needs to be repeated every 18 months to two years.”

These doctors all agree that women no longer have to power through the changes. There are answers. As Cabeca asserts, “This is a time that heralds a second spring of our lives and should be a beautiful journey.”

Linda Sechrist is a senior writer for Natural Awakenings.