Vaginal Atrophy: Causes, Symptoms, and Treatments

During mild to severe vaginal atrophy, you may experience the following vaginal and urinary signs and symptoms -

• Vaginal dryness.
• Vaginal irritation.
• Vaginal discharge.
• Itching in the genitals. 
• Burning during urination.
• Urinary tract infection.
• Urinary incontinence.
• Mild bleeding after intercourse. 
• Pain or discomfort during intercourse.
• Reduction in vaginal moisture during sexual activity.
• Shortening and tightness of the vaginal passage.

(Read more - Vaginal Pain)

Vaginal atrophy is caused by a decrease in the production of estrogen. Due to a decrease in the level of estrogen hormone, the vaginal tissues become thinner, rougher, less flexible and more fragile. Estrogen hormone levels drop and the vaginal lining thins due to:

• After menopause
• During the years leading up to menopause (perimenopause)
• While breastfeeding
• After surgical removal of both ovaries (surgical menopause)
• After pelvic radiation therapy for cancer
• After chemotherapy
• As a side effect of hormonal treatment for breast cancer

Vaginal atrophy caused by menopause may cause problems when you are going through menopause, or it may not appear until many years after menopause. Although this condition is common, not all women who experience menopause develop vaginal atrophy.

(Read more - Itching After Sex)

Regular sex, with or without a partner, can help prevent vaginal atrophy. Sexual activity increases the blood flow to your vagina, which keeps vaginal tissues healthy, and reduces the risk of vaginal problems. 

(Read more - Painful Sex and Menopause)

Your doctor will first recommend that you:|

• Use a vaginal moisturizer to maintain some moisture in the vaginal area. You may need to apply a moisturizer every two to three days. Moisturizers usually last longer than lubricants.
• Use a water-based lubricant to reduce discomfort during intercourse. Choose products that do not contain glycerin as women who are sensitive to glycerin may experience irritation and discomfort. Do not use petroleum jelly or other petroleum-based products if you are using a condom. Petroleum can also tear latex condoms on contact.

(Read more -Vaginismus)

Apart from these, symptoms that cannot be treated with over-the-counter methods can be treated in the following ways:

• Vaginal estrogen: Its advantage is that it works even in small quantities and there are no risks associated with high doses of estrogen because it reaches the blood in less quantity. It is better to use estrogen vaginally rather than taking it in pill form.
• Oral estrogen: Taking estrogen in pill form makes it go into your entire system. Therefore, take it only after knowing the advantages and disadvantages of oral estrogen from the doctor.

Vaginal estrogen therapy is done in many ways. You and your doctor have to decide which one is suitable for you.

• Vaginal estrogen cream: Apply the cream directly on the vagina, especially before sleeping at night. Your doctor will tell you when and how often you have to apply it. Usually women apply it daily for one to three weeks.
• Vaginal estrogen ring: You or your doctor will insert a soft, flexible ring into the upper part of your vagina. The ring releases estrogen hormone continuously and needs to be replaced every three months.
• Vaginal estrogen tablet: In this procedure, you have to insert a vaginal estrogen tablet into your vagina with the help of an applicator. For example, use it once for the first two weeks and then twice a week.

If vaginal dryness is caused by other symptoms of menopause, such as infrequent or severe hot flashes, your doctor may give you estrogen pills, patches, gels or a high-dose estrogen ring with progestin. Progestin hormone is usually given in pill form, but combination estrogen-progestin patches are also easily available. If you can be treated with hormone therapy, then get complete information from your doctor about the severity of the treatment, i.e. its risks, etc.

(Read more - Vagina odor)

Other therapies
Because low doses of estrogen over a long period of time increase the risk of breast cancer and endometrial cancer, researchers are looking into other ways to treat vaginal atrophy. Be sure to tell your doctor if you've had breast cancer and discuss these issues:

• Non-hormonal treatments: You may use moisturizers and lubricants.
• Vaginal estrogen: Your cancer specialist (oncologist) may recommend taking low doses of vaginal estrogen if non-hormonal treatments don't work. If non-hormonal treatments don't help your symptoms.
• Systemic estrogen therapy: This is not usually recommended by doctors, especially if you have breast cancer that's hormone-sensitive.

(Read more - Does menopause decrease libido?)

Vaginal atrophy, also called atrophic vaginitis, is a condition in which the vaginal walls become thin, dry, and inflamed. This problem often occurs in women after menopause, as estrogen hormone levels decrease at this time. This can result in pain, burning, itching, and vaginal discomfort during sex. In some cases, there may also be a burning sensation while urinating or a frequent urge to urinate. Vaginal atrophy can be treated with the use of estrogen therapy, vaginal moisturizers, and lubricants. A healthy lifestyle and regular sex can also help reduce the symptoms. It is important to consult a doctor to choose the right treatment based on individual needs.