Postmenopausal Atrophic Vaginitis
Postmenopausal atrophic vaginitis is the thinning of the walls of the vagina, caused by decreased estrogen levels. This most commonly occurs after menopause. The condition is also called vaginal atrophy.
Menopause is the time in every 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.
The condition is common. More than 40 percent of postmenopausal women have atrophic vaginitis, according to the American Association of Family Physicians. (AAFP)
Symptoms of Vaginal Atrophy
Nearly half of postmenopausal women develop vaginal atrophy, but only about 20 percent of women report symptoms.
Symptoms can include:
- thinning of the vaginal walls
- shortening and tightening of the vaginal canal
- lack of vaginal moisture (vaginal dryness)
- vaginal burning (inflammation)
- spotting of blood after intercourse
- discomfort or pain during intercourse
- pain or burning with urination
- more frequent urinary tract infections
- urinary incontinence (involuntary leakage)
In some women, symptoms occur during perimenopause (the years leading up to menopause). In other women, symptoms may not appear until years later, if ever.
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, including:
- during breast-feeding
- after removal of ovaries (surgical menopause)
- after chemotherapy for cancer
- after pelvic radiation therapy for cancer
- after hormonal therapy for breast cancer
Regular sexual activity helps keep vaginal tissues healthy. A healthy sex life also benefits the circulatory system and improves heart health.
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 vaginally.
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. This makes 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 urination
- more urgent urination
- burning 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. He or she will want to know how long ago you stopped having periods and whether you have ever had cancer. The doctor may quiz you about commercial products you use. Some perfumes, soaps, bath products, deodorants, lubricants, and spermicides can aggravate the sensitive sexual organs.
Your doctor may refer you to a gynecologist for tests, which can include:
- pelvic examination
- vaginal smear test
- vaginal acidity test
- blood test
- urine test
During the pelvic exam, the doctor will palpate (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 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 atrophy.
To test acidity, a paper indicator strip is inserted into the vagina. Your doctor can also collect vaginal secretions for this test.
You may provide samples of blood and urine for laboratory testing and analysis. These tests check several factors, including your estrogen (estradiol) levels.
Treatment of Vaginal Atrophy
With treatment, it is possible to improve your vaginal health and your quality of life. Treatment can focus on symptoms or the underlying cause.
Some helpful over-the-counter products to treat dryness include moisturizers (Silk-E, Replens, or Very Private) or water-based lubricants (K-Y or Astroglide).
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 topically (through the skin) or orally (by mouth).
Taking estrogen through the skin limits how much estrogen gets into the bloodstream. However, topical estrogen treatments can cause endometrial cancer in some women. Call your doctor right away if you are using topical estrogen and experience unusual vaginal bleeding.
Topical estrogen is available in several forms to fit your preferences:
- A vaginal estrogen ring, such as 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, is 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 is usually prescribed one dose per day to start, stepping down to one or two times per week.
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 have ever had cancer, oral estrogen is not usually prescribed.
If your health history does not include cancer, progestin (synthetic progesterone hormone) may also be proscribed in pill or patch form. Your doctor will work with you to decide which option is best for you.
Prevention and Lifestyle
Wearing cotton underwear and not wearing tight-fitting clothing can improve symptoms. Loose cotton clothing improves air circulation around the genitals, making them less ideal environments for bacteria to grow.
A woman with atrophic vaginitis can experience pain during sexual intercourse. However, staying active sexually (either alone or with a partner) 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. Insert capsules or liquid into the vagina an hour or two before sexual activity.
There is 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.