Q: In the last few months I’ve noticed that my vagina feels dry and sex is increasingly painful. I’m approaching the menopause and wondered if there are any natural remedies that you can recommend?

A: During and after the menopause the walls of the vagina can become thinner and less elastic. You may find that you take longer to lubricate and that intercourse can be painful. Thinning and drying of pelvic tissue can occur but women who maintain a healthy weight and eat a healthy diet generally experience few problems with vaginal/bladder weakness in the menopausal years. There are also a number of natural therapies that may help:

 

Make sure you eat a healthy diet rich in hormone balancing phytoestrogens, found in soya, legumes, nuts and seeds, and drink plenty of water. Try cranberry juice (unsweetened of course, or a powdered cranberry, see the Resources Page) especially if you are prone to cystitis.

 

Exercise can help keep your vagina supple and lubricated. Regular sex and masturbation can too. The saying if you don’t use, you lose it doesn’t just apply to your brain and bones it apples to sex too. Regular sex can keep your vagina healthy and happy. Although vaginal dryness is common during the menopause some women do still lubricate rapidly when aroused and the most likely reason for this is that these women continue to have sex once or twice a week.  There are also some really excellent natural vaginal lubricants – one I recommend to my patients is called Yes – see the Resources Page.

 

Kegel exercises can help strengthen your pelvic muscles and combat incontinence and make sex more enjoyable. To find out which muscles you need to use the next time you go to the toilet stop urinating in midstream by contracting your muscles; these are your pelvic floor muscles. Use these muscles to perform the Kegel exercises, contract them and hold for a count of five and then relax. Repeat these ten times and do at least five times a day. If Kegel exercises alone aren’t sufficient studies show that training with pelvic toners that provide resistance produce significantly better pelvic floor muscle strength than did exercise without them.  (Go to the Resources Page for information on two types of pelvic toners.)

 

Avoid douches, talcum powder, perfumed toilet papers, bubble baths and foams as they can irritate the vagina. Avoid washing the inside of your labia with soap too as it will dry out the skin. Spend longer on foreplay as it will help you to lubricate.

 

Motherwort tincture used orally may increase vaginal lubrication and vaginal wall thickness within a month of use. Vitamin E in daily oral doses of 300-400ius for 4-6 weeks has been found to increase vaginal lubrication. Acidophilus inserted vaginally can help prevent yeast infections and create more lubrication. You can get acidophilus in pessaries (called Intrafresh – see the Resources Page) which is a convenient way to get acidophilus into the vagina.  Also you can take a probiotic (like BioKult) orally to help maintain healthy intestinal flora and vaginal balance.

Q: My bottom gets really itchy. I’m too embarrassed to talk to my doctor or pharmacist about it. I try not to scratch but it is really hard. Are there any natural remedies you can recommend?

A: It does sound to me like you have a fungal problem or parasites but if the following measures don’t help you should visit your doctor to be properly investigated. 

 

Once fungal infections take hold in a warm damp area they can be hard to shift and they can make the whole area red and inflamed and scratching will just make the problem worse. As a first line of defence you need to avoid eating any sugars and yeast containing foods. So, bread, cheese, stock cubes, dried fruit and yeast extracts should all be avoided until the infection clears, as should sweets, chocolates and biscuits.

 

Internally you need to take a combination of immune boosting herbs and herbs that will boost beneficial bacteria in your gut. I recommend a combination of herbs as well as a good quality probiotic supplement (e.g. BioKult – see the Resources Page).  You may have a candida infection in the gut and this needs to be investigated and treated.  To confirm whether you have a candida infection you can simply do a saliva test at home and the sample is then send to the lab for analysis. (See the Resources Page for details on how to do this test.)

 

To ease the irritation and itching try using a marigold cream. Add eight drops of tea tree oil into a 60g jar of marigold cream and apply two to three times daily. Avoid using soap or shower gel when washing the affected area, simply rinse with cold water and pat dry or rinse the area with cold water and a few drops of tea tree oil. It will take a few weeks for this to clear up and when the itching goes away you will need to continue treatment for a few weeks to make sure the fungal spores are completely destroyed.

 

To test for parasites you can do a stool sample at home and then send the sample in the containers provided to the lab for analysis.  I use these tests for candida and parasites very regularly in the clinic and they are extremely useful in pinpointing the cause of a problem.  If you are interested in the stool test for parasites see the Resources Page.

 

Breast swelling and pain, especially in the week or so before your period are normal reactions to fluctuating hormone levels. As women reach their 40s, however this discomfort can sometimes develop into severe pain called mastalgia where the breasts become hard and extremely painful. A mastalgia attack can last for up to ten days. The causes are not completely understood but mastalgia may be caused by unusual sensitivity of breast tissue to fluctuating hormones leading up to the menopause.

If you do experience breast pain your immediate fear would be that the pain was due to breast cancer but in most cases mastalgia is a benign condition but you should still see your doctor to have a check up to make sure.  Then try the recommendations below:

 

• If you suffer from breast tenderness make sure you wear a comfortable supportive bra – one that does not irritate the nipple area as you move. 
• Make sure you get plenty of hormone balancing phytoestrogens, found in foods such as soya, chickpeas and lentils and eat them in their traditional form e.g. tofu, hummus etc not textured vegetable protein.  
• Cut down on foods and drinks containing caffeine. They have been shown to increase problems with tender breasts. 
• Up your fibre intake. Research has shown that there may be a link between constipation and a painful breast condition called fibrocystic breast disease. So make sure you drink enough water and have a good intake of fibre to ensure regularity. You may also like to sprinkle some flaxseeds (linseeds) on your cereal in the morning. Don’t, however, include bran in your diet. Bran can make things worse because it contains substances called phytates, which can interfere with the absorption of important nutrients, like magnesium and calcium.
• Vitamin E has been shown to reduce breast pain and tenderness in some studies. Eat foods rich in vitamin E, such as oats, sunflower oil, whole grains, soya oil and leafy green vegetables. You may also like to take a supplement for a couple of months to give you a kick start. (see the Resources Page to get a good vitamin E at 600ius per day)
• Eat some live yogurt every day. Breast tenderness may be related to an excess of oestrogen and the beneficial bacteria in live yogurt can help to reabsorb old hormones and also to increase the efficiency of your bowel movements.  (If you prefer to take beneficial bacteria in supplement form then the one I use in the clinic is BioKult – see the Resources Page).
• Increase your intake of omega 3 fatty acids. Omega 3 fatty acids, found in fish oil, have been found to relieve breast tenderness and fluid retention. Take Omega 3 Plus (see the Resources Page) and eat more fish or sprinkle linseeds and hemp seeds on to your salads and soups.
• The B vitamins are of particular value if you suffer from breast tenderness because they help your liver break down excess oestrogen. Improve your intake of B vitamin foods and think about taking a B complex supplement for a couple of months. (see Resources Page X).
• Older studies showed that supplementing your diet with evening primrose oil that contains GLA (gamma linoleic acid) could reduce breast discomfort, although more recent studies have not backed this up. The suggested dosage is between 240 and 320mg a day. Do bear in mind though that evening primrose oil needs to be taken for about three months to be effective so you need to be patient.
• A number of essential aromatherapy oils, such as lavender, fennel and juniper can encourage lymphatic drainage and help relieve breast pain by helping to regulate hormones. Massage them on your breasts putting one drop of your chosen oil on a teaspoon of carrier oil such as sweet almond or sunflower oil or use a few drops in your bath. 
• The herb ginkgo biloba has proved to be effective according to a French study where women with PMS breast tenderness taking gingko biloba reported less pain that those taking a placebo. Other helpful herbs include agnus castus to balance hormones and milk thistle to help your liver process oestrogen efficiently, allowing excess to be excreted.  (Agnus Castus Plus on the Resources Page contains both agnus castus and milk thistle).

 

Breast self examination

One of the best ways to protect the health of your breasts is to examine yourself for lumps at least once a month by following the steps below:

 

– Lay down and place a pillow under your right shoulder. Next, place your right arm under your head.

– Using your three middle fingers of your left hand, massage your right breast with the pads of your fingers. Check for any lumps or abnormalities. You can move in a circular motion, or up and down. Make sure you use the same motion every month.

– Continue the motion, extending to the outside of the breast to your underarm.

– Repeat on left side.

– Next, repeat exam standing up, with one arm behind your shoulder as you examine each breast. Standing or sitting up allows you to feel the outside of the breast more accurately.

– For added precaution, stand in front of a mirror and squeeze each nipple. Look for any discharge.

– Take note of any dimpling, redness or swelling.

 

If you find anything that concerns you, schedule a visit with your doctor.  The important thing is to learn what is normal for you and to report any changes to your doctor. These changes may include:

 

• Any new lump. It may or may not be painful to touch.
• Unusual thick areas.
• Sticky or bloody discharge from your nipples.
• Any changes in the skin of your breasts or nipples, such as puckering or dimpling.
• An unusual increase in the size of one breast.
• One breast unusually lower than the other.

 

In addition to examining your breasts while lying down, you may also check them while in the shower. Soapy fingers slide easily across the breast and may increase your chances of detecting a change. While standing in a shower, place one arm over your head and lightly soap your breast on that side. Then, using the flat surface of your fingers—not the fingertips—gently move your hand over your breast feeling carefully for any lumps or thickened areas.