What Is Vaginal Atrophy?

Vaginal atrophy, also known as genitourinary syndrome of menopause (GSM), is a condition that occurs when the body produces less estrogen. Vaginal atrophy causes the vaginal walls to experience thinning, dryness, and inflammation. Typically, the onset of vaginal atrophy happens during or after perimenopause or menopause. Common symptoms include vaginal dryness, burning, itchiness, or pain during intercourse. There are several treatment approaches, that typically include the use of non-hormonal or hormonal options.

Signs and Symptoms

There are several signs and symptoms of vaginal atrophy.

Common symptoms may include:

• Vaginal dryness
• Vaginal itchiness
• Vaginal burning
• Vaginal discharge
• Pain or discomfort during intercourse, sometimes with light bleeding
• Burning when urinating
• Urinary incontinence
• Frequency and urgency with urination
• Recurrent urinary tract infections
• Tightening and shortening of the vaginal canal

Causes

The main cause for vaginal atrophy is a lack of estrogen in the body, or a decrease in the production of estrogen. A decrease or lack of estrogen in the body causes the vaginal lining to become thin, dry, and inflamed. The tissue becomes less elastic and more fragile. There are several reasons for a drop in estrogen levels in the body.

Reasons may include:

• After menopause
• Perimenopause (the years leading up to menopause)
• Surgical menopause (if surgery removes both ovaries)
• During breastfeeding
• Certain medications (some birth control pills)
• Pelvic radiation therapy
• Chemotherapy
• Side effect of hormone treatment after breast cancer

Vaginal atrophy is a common condition, although not all women experience it. Symptom onset can occur during the years leading up to menopause, during menopause, or after. Usually, symptoms will increase after menopause. Consult with your healthcare provider if you suspect symptoms of vaginal atrophy.

Risk Factors

There are several factors that may put you at greater risk for developing vaginal atrophy.

Risk factors include:

• Smoking
• No vaginal births
• No regular sexual activity
• Chemotherapy
• Radiation therapy
• Certain medications with antiestrogen properties
• Removal of the ovaries
• Birth control pills
• Breastfeeding
• Immune disorders

Treatment Approaches

There are several different treatment approaches for vaginal atrophy. Treatment will depend on symptom severity and determining which approaches work best. Typically, healthcare providers will start with non-hormonal options, and if those do not resolve symptoms, they may recommend hormonal options.

Non-hormonal options

• Vaginal moisturizers: Moisturizers can restore moisture to the vaginal area and provide longer-lasting relief. The moisturizer may need to be reapplied every few days. Moisturizers typically last longer than lubricants.
• Vaginal lubricants: Lubricants are applied right before sexual activity and provide temporary relief of discomfort caused by vaginal atrophy during intercourse. It is important to avoid products that have a warming agent or glycerin, as some women may experience irritation from these ingredients. Additionally, avoid petroleum-based products if you are using condoms, as it can break down the latex on contact.

Hormonal options

Hormonal options are usually recommended when non-hormonal options do not resolve symptoms. Consult with your doctor before using hormonal options.

Hormonal options include:

• Topical vaginal estrogen: Topical estrogen has the advantage of keeping exposure to estrogen contained to the vaginal area, instead of entering the bloodstream. Topical estrogen comes in cream, tablet, or ring forms. It is considered the most effective hormonal treatment.
• Systemic hormone replacement therapy: This treatment is recommended when vaginal dryness is accompanied by other symptoms of menopause, such as severe hot flashes. This treatment usually comes in pill or patch form and is only used in some cases.

Learn More about Vaginal Atrophy

Vaginal atrophy can cause discomfort and pain if left untreated. If you are experiencing symptoms of vaginal atrophy, consult with your healthcare provider so you can begin treatment and experience relief.

Call a doctor today!