What is vaginal atrophy?
With vaginal atrophy, the tissues of a woman’s vagina no longer work in their normal, healthy way. It happens slowly as the lining of the vagina begins to shrink or thin out. It often occurs in women during the change of life (menopause). This is because women lose the hormone estrogen at that time. Atrophy can also occur in younger women who have a decrease in estrogen. Atrophic vaginitis has also been termed “Genital Syndrome of Menopause.”
What are symptoms of vaginal atrophy?
Symptoms of vaginal atrophy can include:
- Dryness of the vagina
- Burning and/or itching of the vagina
- Pain during sex
- A discharge from the vagina
- Spotting or bleeding
It can also affect your urinary system and cause symptoms. These include going to the bathroom often, having pain when going to the bathroom, and getting urinary tract infections (UTIs).
What causes vaginal atrophy?
During menopause, your body makes less estrogen. Without estrogen, the lining of the vagina can become thinner and less stretchy. The vaginal canal can also narrow and shorten. Less estrogen lowers the amount of normal vaginal fluids. It also changes the acid balance of the vagina. Women who have just had a baby and are breastfeeding also have a drop in estrogen. These symptoms also occur in women who have had their ovaries removed or are taking certain medications (such as aromatase inhibitors for breast cancer treatment).
Diagnosis and Tests
How is vaginal atrophy diagnosed?
The doctor can diagnose atrophy based on your symptoms and physical exam. It will help to know whether or not you are in menopause. Classic signs of atrophy during a pelvic exam include:
- A shortened or narrowed vagina
- Dryness in the lining of the vagina
- Redness and swelling of the lining
- Loss of stretch in the skin of the vulva
- Whitish discoloration to the vagina
Management and Treatment
What are the treatment options for vaginal atrophy?
Some treatments are meant to treat the symptoms of atrophy. Others address the loss of estrogen, which will also act to relieve symptoms.
- Lotions and oils to add moisture and to loosen the vagina can treat dryness. This improves comfort during sex. The lotions won’t 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, Gyne-Moistrin, Silk-E, and others). Others are personal lubricants best used during sexual activity (Astroglide, Lubrin suppository, Condom-Mate suppository, Today brand personal lubricant, K-Y liquid formula). Vaseline is NOT recommended since it can lead to yeast infections. Though many women use olive oil as a moisturizer and lubricant, this can cause an allergic irritation in the vaginal area. Such irritation can occur even if olive oil is tolerated in food. Vitamin E oil is another option, but again may cause allergic reactions. Mineral oil 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 incorrect 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. The local vaginal hormone options will not treat any menopausal symptoms besides the vaginal ones.
- Vaginal 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 (2 types, estradiol or conjugated estrogens), a vaginal pill, or a ring which is left in the vagina for 3 months. After 3 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 would go to all of the 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, improved mood, amongst 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.
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This document was last reviewed on: 06/13/2014