Vaginal Atrophy

“For many women, vaginal atrophy not only makes intercourse painful but also leads to distressing urinary symptoms”.¹

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Depending on the Source (DotS) this Umbrella may include:

Definition

What is vaginal atrophy?

DotS the definition of vaginal atrophy may vary. The (United States) Hormone Health Network’s (HHN) definition is:

“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”.²

The (United States) Mayo Clinic’s definition is:

“Vaginal atrophy (atrophic vaginitis) is thinning, drying and inflammation of the vaginal walls that may occur when your body has less estrogen. Vaginal atrophy occurs most often after menopause”.³

Vulvovaginal Atrophy

What is vulvovaginal atrophy (VVA)?

DotS the definition of vulvovaginal atrophy may vary. The North American Menopause Society’s (NAMS) definition is:

“During perimenopause, less estrogen may cause the tissues of the vulva and the lining of the vagina to become thinner, drier, and less elastic or flexible—a condition known as “vulvovaginal atrophy”. Vaginal secretions are reduced, resulting in decreased lubrication. Reduced levels of estrogen also result in an increase in vaginal pH, which makes the vagina less acidic, just as it was before puberty”.⁴

Genitourinary Syndrome of Menopause

What is the genitourinary syndrome of menopause (GSM)?

In Vaginal Atrophy: Overview the Mayo Clinic explain:

In Vulvovaginal Symptoms After Menopause the Australasian Menopause Society (AMS) elaborate on:

Symptoms

What may be symptoms of vaginal atrophy?

In Vaginal Atrophy: What Are the Symptoms of Vaginal Atrophy? the HHN explain:

In Vaginal Atrophy: Symptoms & Causes – Symptoms the Mayo Clinic explain:

Cause

What causes vaginal atrophy?

In Vaginal Atrophy: Symptoms & Causes – Causes the Mayo Clinic elaborate on:

“Genitourinary syndrome of menopause is caused by a decrease in estrogen production. Less estrogen makes your vaginal tissues thinner, drier, less elastic and more fragile”.⁹

Common or Not

How common is vaginal atrophy?

In NAMS Issues New Guidance on Vulvovaginal Atrophy the NAMS elaborate on:

“Symptoms of vulvovaginal atrophy (VVA), such as lack of lubrication, irritated tissues, painful urination, and pain with intercourse, affect as many as 45% of women after menopause”.¹⁰

Treatment

How can VVA be treated?

In NAMS Issues New Guidance on Vulvovaginal Atrophy dated 29 August 2013, the NAMS note:

“The Position Statement explains that bothersome symptoms can be treated successfully, and many treatments are available, ranging from over-the-counter products to prescription hormonal and nonhormonal products. Which therapy to use depends on how severe the symptoms are, whether the therapy is safe and effective for the individual woman, and what she prefers”.¹¹

The Mayo Clinic explain:

“… make an appointment to see your doctor if you experience painful intercourse that’s not resolved by using a vaginal moisturizer (K-Y Liquibeads, Replens, Sliquid, others) or water-based lubricant (Astroglide, K-Y Jelly, Sliquid, others)”.¹²

Vaginal Estrogen

Can estrogen be placed directly into the vagina?

On page one in Deciding About Hormone Therapy Use published in June 2017, the NAMS elaborate on:

“If you are bothered only by vaginal dryness, you can use very low doses of estrogen placed directly in to the vagina. These low doses generally do not raise blood estrogen levels above postmenopause levels and do not treat hot flashes. You do not need to take a progestogen when using only low doses of estrogen in the vagina. (The MenoNote “Vaginal Dryness” covers this topic in detail)”.¹³

In Vaginal Dryness: Treatment Options the NAMS elaborate on:

Menopausal Hormone Therapy

What is one of the points of consensus about menopausal hormone therapy (MHT) and vaginal atrophy?

One of the points of consensus in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT – endorsed by seven menopause-related organizations – published online 20 June 2016, is:

Sexual Activity

Can regular sexual activity help?

In Changes In the Vagina and Vulva: Vulvovaginal Atrophy the NAMS explain:

“Continuing to have regular vaginal sexual activity through menopause helps keep the vaginal tissues thick and moist and maintains the vagina’s length and width. This helps keep sexual activity pleasurable”.¹⁶

Health Care Provider

What if I think I have vaginal atrophy?

If you think you have vaginal atrophy, it may be in your best interest to choose to talk to your health care provider about this.

In Vaginal Discomfort: Discomfort Not Directly Related To Menopause the NAMS elaborate on:

“Because vaginal discomfort can arise from so many different sources, persistent symptoms of dryness, irritation, burning, itchiness, or pain should be evaluated by a healthcare provider to determine their cause”.¹⁷

The AMS note:

In Vaginal Atrophy: Questions To Ask Your Doctor the HHN include:

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Topic Last Updated:  06 March 2020 – Topic Last Reviewed: 17 February 2020