Postmenopausal Atrophic Vaginitis
Postmenopausal atrophic vaginitis, or
vaginal atrophy, is the thinning of the walls of the vagina caused by decreased
estrogen levels. This most commonly occurs after menopause.
Menopause is the time in a woman’s
life, usually between ages 45 and 55, when her ovaries no longer produce eggs.
She also stops having menstrual periods. A woman is postmenopausal when she has
not had a period for 12 months or more.
Women with vaginal atrophy have a
greater chance of chronic vaginal infections and urinary function problems. It
can also make sexual intercourse painful.
According to the American Association of Family
Physicians, up to 40
percent of postmenopausal women have atrophic vaginitis.
Symptoms of Vaginal Atrophy
While vaginal atrophy is common, only
20 or 25
percent of women seek medical attention from their doctor.
In some women, symptoms occur during
perimenopause, or the years leading up to menopause. In other women, symptoms
may not appear until years later, if ever.
Symptoms can include:
- thinning of the vaginal walls
- shortening and tightening of the
- lack of vaginal moisture (vaginal
- vaginal burning (inflammation)
- spotting of blood after intercourse
- discomfort or pain during intercourse
- pain or burning with urination
- more frequent urinary tract
- urinary incontinence (involuntary
Causes of Vaginal Atrophy
The cause of atrophic vaginitis is a
decline in estrogen. Without estrogen, vaginal tissue thins and dries out. It
becomes less elastic, more fragile, and more easily injured.
A decline in estrogen can occur at
other times besides menopause, including:
- during breast-feeding
- after removal of ovaries (surgical
- after chemotherapy for treatment of cancer
- after pelvic radiation therapy for treatment
- after hormonal therapy for treatment
of breast cancer
Regular sexual activity helps keep vaginal tissues
healthy. A healthy sex life also benefits the circulatory system and improves
Risk Factors for Vaginal Atrophy
Some women are more likely than
others to get atrophic vaginitis. Women who have never given birth vaginally
are more prone to vaginal atrophy than women who delivered their babies
Smoking impairs blood circulation, depriving the vagina
and other tissues of oxygen. Tissue thinning occurs where blood flow is
decreased or restricted. Smokers are also less responsive to estrogen therapy
in pill form.
Atrophic vaginitis increases a
woman’s risk of contracting vaginal infections. Atrophy causes changes in the
acidic environment of the vagina, making it easier for bacteria, yeast, and
other organisms to thrive.
It also increases the risk of urinary
system atrophy (genitourinary atrophy). Symptoms associated with
atrophy-related urinary tract problems include more frequent or more urgent
urination or a burning sensation during urination.
Some women may also have incontinence
and get more urinary tract infections.
Diagnosing Vaginal Atrophy
See your doctor right away if sexual
intercourse is painful, even with lubrication. You should also see your doctor
if you experience unusual vaginal bleeding, discharge, burning, or soreness.
Your doctor will ask you questions
about your health history. They’ll want to know how long ago you stopped having
periods and whether you have ever had cancer. The doctor may ask what, if any,
commercial or over-the-counter products you use. Some perfumes, soaps, bath
products, deodorants, lubricants, and spermicides can aggravate the sensitive
Your doctor may refer you to a
gynecologist for tests and a physical examination. During a pelvic exam, they
will palpate or feel your pelvic organs. The doctor will also examine your
external genitalia for physical signs of atrophy, such as:
- pale, smooth, shiny vaginal lining
- loss of elasticity
- sparse pubic hair
- smooth, thin external genitalia
- stretching of uterine support tissue
- pelvic organ prolapse (bulges in the
walls of the vagina)
The doctor might order the following
- pelvic examination
- vaginal smear test
- vaginal acidity test
- blood test
- urine test
The smear test is a microscopic
examination of tissue that has been scraped from the vaginal walls. It looks
for certain types of cells and bacteria that are more prevalent with vaginal
To test acidity, a paper indicator
strip is inserted into the vagina. Your doctor can also collect vaginal secretions
for this test.
You may also be asked to provide
samples of blood and urine for laboratory testing and analysis. These tests
check several factors, including your estrogen levels.
Treatment of Vaginal Atrophy
With treatment, it’s possible to
improve your vaginal health and your quality of life. Treatment can focus on
symptoms or the underlying cause.
Over-the-counter moisturizers or
water-based lubricants can help treat dryness.
If symptoms are severe, your doctor
may recommend estrogen
replacement therapy. Estrogen improves vaginal
elasticity and natural moisture. It usually works in just a few weeks. Estrogen
can be taken either topically or orally.
Taking estrogen through the skin
limits how much estrogen gets into the bloodstream. However, estrogen
treatments have been shown to increase the risk of endometrial cancer. Call
your doctor right away if you’re using topical estrogen and experience unusual
Topical estrogen is available in
several forms to fit your preferences:
- A vaginal estrogen ring, such as
Estring. Estring is a flexible, soft ring inserted into the upper part of the
vagina by you or your doctor. It releases a constant dose of estrogen and only
has to be replaced every three months.
- A vaginal estrogen cream, such as
Premarin or Estrace. These types of medications are inserted into the vagina
with an applicator at bedtime. Your doctor may prescribe the cream daily for a
couple of weeks, then step down to two or three times per week.
- A vaginal estrogen tablet, such as
Vagifem, is inserted into the vagina using a disposable applicator. It’s
usually prescribed one dose per day to start, stepping down to one or two times
During menopause, oral estrogen is
often used to treat hot flashes and vaginal dryness. But prolonged use
heightens the risk of certain cancers. If you’ve ever had cancer, oral estrogen
is not usually prescribed.
If your health history includes cancer, progestin
(synthetic progesterone hormone) may be proscribed in addition to estrogen in pill
or patch form. Your doctor will work with you to decide which option is best
Prevention and Lifestyle
Besides medication, there are certain
lifestyle changes you can make as well.
Wearing cotton underwear and
loose-fitting clothing can improve symptoms. Loose cotton clothing improves air
circulation around the genitals, making them a less ideal environment for
bacteria to grow.
A woman with atrophic vaginitis can
experience pain during sexual intercourse. However, staying sexually active
enhances blood circulation in the vagina and stimulates natural moisture. Sexual
activity has no effect on estrogen levels. But by improving blood circulation,
it keeps your sexual organs healthier for longer. Allowing time to become
sexually aroused can make sexual intercourse more comfortable.
Vitamin E oil can also be used as a lubricant.
There’s also some evidence that vitamin D increases moisture in the vagina.
Vitamin D also helps the body absorb calcium. This helps to slow or prevent
postmenopausal bone loss, especially when combined with regular exercise.