PCOS And Vaginal Dryness: Causes, Symptoms, Treatment

PCOS can cause many symptoms. In some patients, PCOS vaginal dryness is a complaint. While it is not common, when it happens vaginal dryness in PCOS may be linked to hormonal imbalances that reduce natural lubrication in the vagina. Let’s gain a better understanding of how PCOS and vaginal dryness can be related and what you can do.

What Typically Causes Vaginal Dryness?

Vaginal dryness happens when the tissues in the vagina lack proper lubrication. This can make the vaginal area feel dry, itchy, or irritated.

A Drop In Estrogen Levels – Most Commonly From Menopause

Many factors can lead to this issue. A drop in estrogen levels is a common cause. This often happens during menopause, but can also happen during other times like when a woman is breastfeeding.

Certain Medications

Some medications can affect vaginal lubrication. 

• Antihistamines: Antihistamines are usually used for allergies. For some patients these medications can have a drying effect on mucous membranes throughout the body, including their vaginal tissue.
• Antidepressants: Certain types of antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), can affect hormonal balance. This can lead to reduced vaginal lubrication.
• Birth Control Pills: Some hormonal contraceptives can alter estrogen levels, leading to vaginal dryness. Many patients with PCOS are on hormonal contraception to help to regulate their menstrual cycles.
• Anti-estrogen Medications: When estrogen is reduced by medications, it can lead to vaginal dryness. Anti estrogen medications are typically used in the treatment of breast cancer or for other medical conditions. 
• Decongestants: Over the counter cold medications that have decongestants can cause vaginal dryness. For example, pseudoephedrine, which is used to relieve nasal congestion, can have a systemic drying effect.
• Medications For High Blood Pressure: Some antihypertensive medications can cause changes in blood flow and dryness.
• Anti-seizure Medications: Certain drugs used for epilepsy and other conditions can lead to dryness.
• Diuretics: Often used to treat high blood pressure and edema, these can reduce overall body moisture levels, including vaginal lubrication.

If you are on one of the above medications, it is important to talk to your doctor. It is possible that the dryness you are experiencing in your vaginal tissues is not a result of PCOS but rather from a medication. 

Stress And Anxiety

Stress and anxiety can also play a role. This is a multifactorial contributor and it may be hard to pinpoint exactly what the cause is.

• Cortisol Production: When the body is under stress, it releases cortisol, a stress hormone. Elevated cortisol levels can interfere with the balance of sex hormones like estrogen and progesterone, which are crucial for maintaining vaginal lubrication.
• Estrogen Suppression: Chronic stress can suppress the production of estrogen. Estrogen plays a key role in maintaining the health and moisture of vaginal tissues. Reduced estrogen levels can lead to thinning of the vaginal walls and decreased natural lubrication.
• Anxiety and Mental Distraction: Stress often leads to anxiety and preoccupation with stressors. This mental state can distract from sexual stimuli and arousal, reducing the body’s natural lubrication response.
• Decreased Libido: Stress can reduce sexual desire, which is closely linked to the physiological process of lubrication. Lower sexual desire often translates to reduced physical readiness for sexual activity, including lubrication.

Lifestyle changes: abrupt changes in lifestyle can influence hormone levels

• Exercise: long durations of exercise can suppress ovarian hormone production
• A rapid decrease in weight can suppress ovarian hormone production

Certain Products

Harsh soaps, douches, or scented products can upset the delicate balance in the vagina. This may lead to dryness and discomfort.

Excessive Alcohol Use

Having a drink here and there is unlikely to cause vaginal dryness. However, it is possible that excessive use as well as chronic use of alcohol could impact vaginal lubrication in women of reproductive age.

• Dehydration: Alcohol is a diuretic, which means it increases urine production and can lead to dehydration. Dehydration affects the entire body, including mucous membranes, leading to dryness in various areas, including the vaginal tissues.
• Hormonal Imbalance: Excessive alcohol consumption can disrupt the balance of hormones in the body. Hormones like estrogen are crucial for maintaining vaginal lubrication. Alcohol can interfere with the liver’s ability to metabolize and regulate hormones, potentially leading to reduced estrogen levels and vaginal dryness.
• Nervous System Impact: Alcohol affects the central nervous system, altering the normal function of the body’s autonomic nervous system. This can impact sexual arousal and the body’s natural lubrication response during sexual activity.

Aside from potentially contributing to vaginal dryness, other symptoms of PCOS can also be made worse by alcohol. If you think you may be drinking too much, be sure to seek medical attention from your doctor as soon as possible.

​Other Chronic Health Conditions

Some health conditions like diabetes or autoimmune disorders may contribute to vaginal dryness. These can affect hormone levels or blood flow.

What Are The Hormonal Imbalances In Traditional PCOS?

Polycystic ovary syndrome (PCOS) is a hormonal disorder. It causes changes in hormone levels and we usually see high androgen levels. Traditional PCOS usually has elevated estrogen levels. 

Understanding Estrone

PCOS is often associated with elevated levels of estrone. Estrone is a form of estrogen produced from the conversion of androgens in adipose tissue (fat). This is especially true in women with higher body weight or obesity. This is because more fat tissue can lead to increased estrone production. Since estrone is a less potent estrogen than estradiol, vaginal dryness can be present even if estrone is higher than normal.

Understanding Estradiol

Estradiol levels can be normal or slightly elevated or slightly low but can vary. Since ovulation is often irregular or absent in PCOS, the cyclical pattern of estradiol secretion is disrupted. This can lead to periods of both lower and higher estradiol levels compared to women with regular menstrual cycles.

What Are The Hormonal Imbalances In Lean PCOS?

Lean PCOS is a form of polycystic ovary syndrome that affects women with a normal body mass index. Even though these patients have a healthy weight, they still suffer from hormonal changes and hormonal imbalances.

Because these patients do not have excessive adipose tissue, they are not likely to have an excess of estrogen as in the traditional form of PCOS. Patients with Lean PCOS will still have an excess of male hormones (increased testosterone levels) as well as symptoms of excessive hair growth, acne, irregular periods, and insulin resistance / metabolic syndrome. 

Hormonal Disruptions Leading To Vaginal Dryness In PCOS

PCOS is a complicated condition when it comes to hormones. Patients with PCOS each can have unique hormonal profiles and the underlying cause of vaginal dryness may not be straightforward.  

The Impact Of Luteinizing Hormone On Estrogen

In PCOS, there is often a chronically elevated baseline levels of LH. This elevation is not typically associated with the normal cyclical LH surge seen in a healthy menstrual cycle.

High LH levels stimulate the theca cells in the ovaries to produce more androgens (male hormones like testosterone). These androgens can be converted to estrogen in peripheral tissues, but the process may not be efficient enough to produce consistently high estrogen levels.

The elevated LH can disrupt normal follicular development, leading to many small, immature follicles (polycystic ovaries). These immature follicles do not produce estrogen effectively, leading to an imbalance.

High Levels Of LH

High levels of LH do not directly mean high estrogen. In PCOS, chronically high LH can disrupt estrogen production. Estrogen levels in PCOS can be inconsistent—they may be normal, low, or sometimes high due to the conversion of androgens. However, the usual patterns of estrogen production are disrupted. 

High LH in PCOS is more linked to high androgens than to high estrogen. So, even though LH affects estrogen production, high LH in PCOS doesn’t simply result in high estrogen. The hormonal imbalance in PCOS is more complex and involves disrupted feedback and irregular follicle development.

LH To FSH Ratio Elevated In PCOS

The LH to FSH ratio is often elevated in PCOS. This can disrupt the normal function of FSH in stimulating proper follicle maturation and estrogen production.

Negative Feedback: High levels of estrogen and progesterone from the growing follicles and corpus luteum provide negative feedback to the pituitary gland to reduce the secretion of FSH and LH, preventing the maturation of additional follicles during that cycle.

Positive Feedback: Just before ovulation, high estrogen levels create a positive feedback loop, causing the pituitary gland to release a surge of LH (and to a lesser extent, FSH), triggering ovulation.

These feedback loops, which play a crucial role in the normal menstrual cycle, can be variably disrupted in patients who have polycystic ovarian syndrome.

Treating PCOS Vaginal Dryness

Vaginal dryness can have a significant impact on a person’s quality of life, their intimate relationships, and subsequently their overall health. It can cause painful intercourse and make you more susceptible to yeast infections. Here are some ways to treat symptoms of vaginal dryness. Remember it is also very important to talk about all treatment options with your healthcare provider so that a serious underlying condition is not missed.

Over-the-Counter (OTC) Options

First, let’s take a look at some over the counter options.

• Vaginal Moisturizers: Products like Replens or vaginal hyaluronic acid, which help maintain vaginal moisture and can be used regularly to provide long-term relief.
• Water-based Lubricants: Such as Astroglide and KY Jelly, which are easy to wash off and are less likely to cause irritation.
• Silicone-based Lubricants: Like Pjur and Wet Platinum, which last longer and are less likely to cause irritation, but can be harder to wash off.
• Oil-based Lubricants: Such as coconut oil and vitamin E oil, which are longer-lasting but should not be used with latex condoms as they can cause breakage.
• Hyaluronic Acid Suppositories: Products like Hyalo GYN, which help maintain vaginal hydration, can be inserted into the vagina.

Lifestyle Changes

​

Lifestyle changes can also help to improve your overall health as well as vaginal health.

• Hydration:Increasing water intake can help maintain overall hydration, including vaginal moisture.
• Diet:A balanced diet rich in phytoestrogens (found in soy products) may help some women maintain hormonal balance. Probiotic fibers to ensure a healthy microbiome can ensure healthy vaginal flora and reduce the growth of microorganizsms that can cause discomfort and also improve hormone metabolism.
• Avoiding Irritants: Avoiding scented soaps, douches, and bubble baths that can irritate the vaginal area.
• Regular Sexual Activity: Regular sexual activity, including masturbation, can promote vaginal lubrication and elasticity.

Prescription Options

For some patients, healthcare professionals may also consider prescription treatment. 

Topical estrogen therapy can be a helpful medical treatment in this case.

• Creams: Such as Estrace and Premarin, which are applied directly to the vaginal area to help replenish estrogen locally.
• Tablets: Such as Vagifem, which are inserted into the vagina.
• Rings: Such as Estring, which are placed in the vagina and release a low dose of estrogen over several months.

Systemic Hormone Replacement Therapy (HRT) is usually reserved for patients with menopause and is unlikely to be used in patients with PCOS.

Selective Estrogen Receptor Modulators (SERMs) may also be considered. Ospemifene (Osphena) is a medication taken orally that can help treat painful intercourse due to vaginal dryness.

Finally, you may have also heard of Prasterone (Intrarosa). This is a vaginal insert that helps treat moderate to severe dyspareunia (painful intercourse) due to menopause.

PCOS And Vaginal Dryness: Summary

Vaginal dryness in women with PCOS, although not a common condition, can be a significant issue linked to hormonal imbalances that reduce natural lubrication in the vagina. This can lead to various symptoms like painful sex and vulvar irritation. Many factors, including low estrogen levels, high levels of androgens, certain medications, stress, and excessive alcohol use, can contribute to vaginal dryness. Addressing this issue involves a holistic approach, including self-care practices like maintaining a healthy diet, regular exercise, and drinking plenty of water. Over-the-counter vaginal lubricants and vaginal moisturizers can provide relief during sexual intercourse, while prescription options like topical hormone therapy may be necessary for some.

Managing PCOS symptoms and related vaginal dryness often starts with a thorough evaluation, including blood tests to check hormone levels. Adjusting hormonal contraception may relieve this symptom. Stress management and addressing mental health are also crucial, as they play a significant role in overall reproductive health and sexual health.

It’s important to consult with PCOS experts for a comprehensive guide on how to manage this hormonal condition. Understanding and addressing vaginal dryness can go a long way in improving quality of life, reducing the risk of sexual dysfunction, and having a healthy vaginal microbiome.

In summary, addressing vaginal dryness in PCOS involves a combination of lifestyle changes, medical treatments, and ongoing support from healthcare providers to ensure overall well-being and reproductive health.