Vaginal Atrophy

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JoAnn E. Manson, MD, PHD

Additional Resources
Menopause Map
Mayo Clinic

The endocrine system is a network of glands and organs that produce, store, and secrete hormones. These hormones are very important for a woman’s health especially during the years when she might become pregnant. Sometimes called “the change,” menopause is the time, around age 50, when a woman’s ovaries produce fewer hormones and she stops having a monthly period. Menopause takes place gradually over four or five years. A woman may experience a number of uncomfortable symptoms during this time, including vaginal dryness.

What is vaginal atrophy?

Vaginal atrophy, also called VVA or vulvovaginal atrophy, is a condition in which the lining of the vagina becomes thinner and drier. This condition is also called genito urinary syndrome of menopause (GMS). It can lead to a number of vaginal and urinary tract problems, especially for older women during and after menopause.

A drop in estrogen, a female sex hormone, causes the vagina to become dryer and more fragile. This is the leading cause of vaginal atrophy. A drop in estrogen levels may occur:

  • During perimenopause (the years leading up to menopause)
  • After menopause
  • When breastfeeding
  • When taking certain medications
  • If you smoke
  • After surgical removal of both ovaries
  • After radiation therapy for ovarian or uterine cancer
  • As a side effect of breast cancer treatment

What are the symptoms of vaginal atrophy?

You may have no symptoms at all. or you may have:

  • Vaginal dryness, itching or irritation
  • Burning feelings in the vagina
  • Discomfort or pain during sex
  • Light bleeding after sex
  • Burning sensation when you urinate
  • Frequent or strong urges to urinate
  • Urinary incontinence (the loss of bladder control)

Vaginal atrophy is not only a nuisance. It can cause vaginal and urinary tract infections. It can also have an adverse emotional effect on you and your sexual partner.

Sexual activity is a very important part of overall health? The vaginal dryness often associated with vaginal atrophy usually becomes worse with a lack of sexual activity. Sex stimulates blood flow in the vagina and aids in the production of vaginal fluids. So, sex actually keeps the vagina lubricated and healthy.

  • About 50% of post-menopausal women experience vaginal atrophy symptoms, including irritation and dryness
  • Only about 7% seek treatment at the first sign of symptoms
  • 1 in 4 women with vaginal atrophy report that it has a negative effect on other areas of their life, including sleep, sexual health, and general enjoyment

Source: National Center for Biotechnology Information

What is vaginal atrophy diagnosed?

Vaginal atrophy is often unreported because women think it will just go away on its own. It usually will not and tends to get worse. Therefore, if you think you may have vaginal atrophy, it’s important to talk with your healthcare provider. He or she can diagnose it very quickly during your next pelvic exam. Remember, vaginal health is very important to your overall health!

What are the treatment options?

For many woman, non-prescription (over-the-counter) treatments can help, especially if symptoms are mild. Your healthcare provider may recommend vaginal lubricants or vaginal moisturizers that you can use, especially during sexual activity.

Prescription treatments include low-dose estrogen therapies, including:

  • Estrogen cream placed in the vagina at bedtime
  • Estrogen ring, a soft, flexible ring inserted into the vagina every three months
  • Estrogen tablet inserted into the vagina with a disposable applicator
  • Systemic estrogen, also known as hormone therapy, available in a pill, patch, gel, or spray form
  • Ospemifene, an oral, non-estrogen medication

Depending on the treatment, there may be health risks that you’ll want to discuss with your healthcare provider.

Questions to ask your doctor

  • Is my condition temporary or long-term?
  • Are there non-prescription (over-the-counter) treatments that might help?
  • What are some other ways to treat my condition?
  • What are the risks and benefits of my treatment options?

The development of this resource was made from the generous support of our sponsor TherapeuticsMD.