Vaginal Atrophy

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 referred to as vulvovaginal atrophy, urogenital atrophy, or atrophic vaginitis) is a condition in which the lining of the vagina becomes thinner and drier. This condition can lead to vaginal and urinary tract problems.

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 burning feelings in your vagina
• Discolored and unpleasant smelling, or copious vaginal mucous
• Decreased lubrication, discomfort, or pain during sexual intercourse
• Light bleeding after intercourse or random vaginal spotting
• Burning sensation when you urinate (pass water)
• Frequent, strong urges to urinate (overactive bladder)
• Urinary incontinence (unintended release of urine)

Vaginal atrophy can cause vaginal and urinary tract infections (UTIs).

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

How is vaginal atrophy diagnosed?

Your medical provider will ask about your symptoms and do a pelvic exam to look at the appearance of your vagina. Your medical provider also may test a urine sample, perform a Pap test or ultrasound, and/or measure blood estrogen levels.

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 Therapeutics MD.