How is vaginal atrophy (atrophic vaginitis) treated?
You and your healthcare provider will work closely together to come up with a treatment plan for vaginal atrophy. They’ll help you decide which plan is most effective based on your symptoms and the severity of them. Estrogen therapy is considered to be the most effective.
Some treatments are meant to treat the symptoms of atrophy. Others address the loss of estrogen, specifically, which will also act to relieve symptoms.
- Lubricants and moisturizers to add moisture and to loosen the vagina can treat dryness. This improves comfort during sex. The moisturizers won’t completely restore the health of the vagina. Multiple brand names are available over-the-counter. Some are vaginal moisturizers for irritation and dryness throughout the day, similar to a skin moisturizer (Replens, Hyalofemme, Silk-E, and others). Others are personal lubricants best used during sexual activity (Astroglide, Uber Lube, Condom-Mate suppository, Today brand personal lubricant, K-Y liquid formula). Vaseline is NOT recommended for use inside the vagina because it can lead to yeast infections. Though many women use olive or coconut oils as a moisturizer and lubricant, occasionally this may cause an allergic irritation in the vaginal area. Vitamin E and mineral oils should be avoided.
- Dilators are devices to widen (dilate) the vagina to enable you to go back to having sex. Women often start with a narrow dilator and move on to larger sizes over time. This is done until the vagina is wide enough to fit a penis for sexual activity without pain. The best results are obtained when dilators are used in conjunction with local hormone therapy.
- Hormone therapy not only improves symptoms of vaginal atrophy the best, but also brings back the health of the skin by restoring the normal acid balance of the vagina, thickening the skin (back to how it was originally), maintaining natural moisture and improving bacterial balance. Over the counter repHresh vaginal gel can also be used to help restore normal vaginal pH. Douching should be avoided.
What are the hormonal treatment options?
Luckily, for women who are only having vaginal atrophy symptoms, there are several options that allow estrogen to be delivered only to the vagina. These options can help to avoid high hormone levels in the rest of the body. Women who are having multiple other menopausal symptoms — such as hot flashes and difficulty sleeping — may choose to use hormone therapy at higher doses to treat all of their symptoms (referred to as systemic hormone therapy). The local vaginal hormone options will not treat any menopausal symptoms besides the vaginal ones.
- Vaginal low-dose estrogen therapy (local therapy). These formulations are meant to treat only vaginal symptoms, as they are not being absorbed by the rest of the body. They are available in the forms of a cream (two types, estradiol or conjugated estrogens), a vaginal pill/suppository, or a ring which is left in the vagina for three months. After three months, the old ring is removed and a new one is inserted. Many women confuse vaginal estrogen only forms of treatment with systemic hormone therapy, and unnecessarily worry about risks of blood clots, heart disease, etc.
- Systemic hormone therapy (also called hormone replacement therapy). This is taken in higher doses that go to other cells of the body, not just to the vagina. If you are more than 10 years past menopause, or only have vaginal symptoms, you will more likely be using local therapy. However many women on systemic hormone therapy benefit from improved bone health, vaginal health, better sleep, less hot flashes and improved mood, among other health benefits. You should discuss with your doctor whether systemic hormone therapy is right for you.
- Ospemifene (Osphena) is the first non-estrogen pill that is taken by mouth daily with food. Its benefits to the vagina are similar to that of estrogen. Serious but uncommon side effects can include blood clots and stimulation (thickening) of the lining of the uterus. Some women may also notice more hot flashes, vaginal discharge and muscle spasms, though the majority of women will have no symptoms.
Mild symptoms can usually be managed with over-the-counter options. Prescriptions are available for moderate to severe symptoms.
Sexual activity should not be avoided if you have vaginal atrophy. A lack of sexual activity actually worsens the condition. Sex stimulates blood flow in the vagina and aids in the production of fluids so, therefore, sex actually keeps the vagina healthy.
Are there complications/side effects of treatment?
Pay attention to any new symptoms that come after you start treatment. These could be irritation to the skin, more pain and/or discharge. Discuss any possible side effects with your healthcare provider. Don’t hesitate to consult your healthcare provider if you’re uncomfortable!