Vaginal atrophy

What is vaginal atrophy?

Vaginal atrophy is a condition encountered mostly during menopause, in which the vaginal tissue starts showing signs of atrophy such as dryness, thinness and sometimes inflammation. This occurs due to lowered oestrogen levels in the body after menopause.

What are its main signs and symptoms?

Some common symptoms of vaginal atrophy are as follows:

• Unusual spotting or bleeding or other unusual discharge from the vagina
• Burning and/or itching sensation in the vagina
• Dryness of the vagina
• Painful sexual activity
• Increased frequency of urination, painful urination or frequent urinary tract infections (if the urinary tract is inflamed as well)

What are the main causes?

Vaginal atrophy is mainly seen in women with reduced levels of oestrogen, which occurs due to:

• Removal of the ovaries
• Pregnancy
• Just after delivering a baby
• Breastfeeding
• Undergoing breast cancer treatment with medications such as aromatase inhibitors.

How is it diagnosed?

The physician takes a complete medical history, and a thorough physical examination of the vagina is carried out to diagnose atrophy. Signs that help establish the diagnosis on physical examination include are – a red, swollen, dried, shortened or narrowed vagina with a whitish discolouration and loss of vaginal elasticity.

Management of vaginal atrophy aims at either relieving the symptoms or addressing the loss of oestrogen, and it includes:

• Use of lotions and oils to treat dryness by providing moistness
• Use of vaginal lubricants
• Use of vaginal gels
• Use of dilators in conjunction with local hormone therapy, which improves the symptoms of vaginal atrophy along with the health of the skin. This is achieved by restoration of the normal acid balance of the vagina, maintaining natural moisture, thickening the skin, and improving bacterial balance

Hormonal treatment includes:

• Local vaginal oestrogen therapy, which is used in the cream form or as tablets or rings, will reduce the symptoms of vaginal dryness.
• Systemic hormone replacement therapy can also be used.

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3. Cleveland Clinic. [Internet]. Cleveland, Ohio. Vaginal Atrophy: Management and Treatment
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5. U. S Food and Drug Association. [Internet]. Estrogen and Estrogen/Progestin Drug Products to Treat Vasomotor Symptoms and Vulvar and Vaginal Atrophy Symptoms — Recommendations for Clinical Evaluation