11 Tips to Ease Vaginal Symptoms After Surgical Menopause

Natural menopause happens slowly. Over time, hormones like estrogen and progesterone decrease and your periods stop for good. But surgical menopause (removing your ovaries during endometrial cancer surgery) causes a drastic drop in your hormones. That can make physical and emotional menopause symptoms more intense. Treatments, medications, support from your loved ones, and at-home strategies can help you get through this change.

After treatment, you’ll quickly notice menopause symptoms like:

• Hot flashes
• Night sweats
• Mood changes
• Memory issues
• Brain fog
• Vaginal dryness
• Painful sex
• Trouble having an orgasm
• Lack of sexual desire 

Each of these issues can be a challenge to manage, especially if you’re under the age of 45 and weren’t expecting to go through menopause for years . But there are ways to ease this transition. The following tips will help you get started.

Right after surgery, your doctor will give you medication to manage your pain. Take it exactly as prescribed. If you miss a dose, the pain may return. Although you’ll feel tired, try to gently move around. This can help lessen pain after hysterectomy and also decrease your chance of blood clots. If your doctor says it’s OK, slowly increase your physical activity over time. A heating pad on your stomach can also relieve postsurgical pelvic pain.

Different endometrial cancer treatments, from surgery to chemotherapy and radiation, can dry out the lining of your vagina. That can cause burning, itching, soreness, discharge, and pain during sex. To keep vaginal dryness from getting worse, wash with gentle, unscented soap, drink enough water every day, and wear 100% cotton underwear. Your doctor may prescribe a low-dose hormone treatment, like estrogen cream, that can also help.

Nonhormonal vaginal moisturizers add water to the cells inside your vagina. They can relieve some dryness and help irritated tissues heal. Some kinds, like Revaree, contain hyaluronic acid to help lock in moisture. Other options include Replens. To see results, moisturize three to five times a week. Lubricants offer fast, short-term relief of dryness. You use them right before sex. Choose a kind that’s water-based, unscented, and unflavored.

Endometrial cancer treatment can make your vaginal tissue more sensitive. Avoid vaginal products that contain glycerin, propylene glycol, petroleum, or chlorhexidine gluconate. They may increase your risk of infections or cause irritation. Choose a lubricant that’s close to the natural pH of your vagina. That can help keep any dryness from getting worse. Lubricant options to try include Good Clean Love Almost Naked and Ah! Yes.

Endometrial cancer can change how you view yourself and how you feel about your body. That can impact your sexual health. Talk to your partner about what feels good and what doesn’t. If you experience vaginal pain after hysterectomy during sex, you might spend more time on foreplay. Choose positions that let you control the pace and keep pressure off any sore parts of your body. You can also explore other ways to be intimate, like using a vibrator.

Radiation and surgery may cause scar tissue to form inside your vagina, which can make it shorter and more narrow. This condition, called vaginal stenosis, makes sex and pelvic exams very painful. Dilator therapy can help. You insert a thin, tubelike device (dilator) into your vagina for a few minutes at a time to gently stretch and expand your vaginal tissue. Your doctor can suggest the size of dilator to try and how often to use it. 

The muscles around your vagina, anus, and urethra (where urine comes out) are your “pelvic floor. “ Endometrial cancer treatments can weaken it, causing symptoms like pelvic pain and constipation. In pelvic floor therapy, a trained therapist can help you find your pelvic floor and teach you exercises to strengthen and stretch it. You might have one or two sessions a week for eight to 12 weeks. Then, you’ll keep doing exercises on your own. 

Hormone replacement therapy (estrogen) can relieve menopause symptoms, but it’s not safe for every endometrial cancer survivor. Talk to your doctor about which options are best for you, including nonhormonal treatments. For instance, hot flashes and night sweats can be reduced with some antidepressants, an antiseizure drug called gabapentin, or fezolinetant, a new drug that blocks a brain receptor that controls your body temperature.

There’s no “right” way to feel after endometrial cancer treatment. It’s common to feel sad, angry, lonely, or stressed about what to do next, or all of the above. Talking openly to your loved ones may help. Instead of pretending that everything’s fine, it’s OK to say, “I’m having a bad cancer day.” Joining a support group of other survivors or opening up to a therapist may help you better understand the feelings that you have.

Support your overall health by eating nutritious foods like fruits and vegetables, whole grains, low-fat dairy, chicken, fish, and plant-based protein like beans. Avoid ultraprocessed foods, added sugars, unhealthy fats, and processed or red meat. Regular physical activity can help you build strength and reconnect with your body. Gentle mind-body exercises like tai chi and yoga can also improve your mood. 

If your uterus and ovaries were removed as part of your endometrial cancer treatment, you may get aroused differently now. Give yourself time to figure out your “new normal.” Talk to your partner about new ways you can feel intimate. Sometimes, it can help to schedule sex. On days you don’t feel like it, you can still hold hands, snuggle, or enjoy foreplay. If you’re still struggling, a counselor or sex therapist can offer more support.