What Is Vaginal Atrophy?

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Vaginal atrophy is a common condition in which the walls of the vagina become thin, dry, and less elastic. It is one of the conditions associated with the genitourinary syndrome of menopause (GSM) which refers to a collection of symptoms and signs caused by a lack of oestrogen in menopausal women which results in changes to the female genitalia, urethra, and bladder.


Understanding Vaginal Atrophy

It is usually caused by a decrease in oestrogen and is most common in post-menopausal women but can also occur in women who have had their ovaries removed (usually during a hysterectomy) or take certain medications. The condition can have a significant impact on a woman’s quality of life, causing symptoms such as vaginal dryness, itching, burning, and pain during sexual intercourse.

Fortunately, there are several successful treatments available that can ease the symptoms of vaginal atrophy. Mild cases of vaginal atrophy can often be treated with lubricants, while more severe cases may require the use of topical or oral oestrogen therapy.


What Causes Vaginal Atrophy?

Vaginal atrophy usually occurs after menopause when the ovaries can no longer produce oestrogen. Oestrogen is the female hormone responsible for healthy skin, bone structure and a natural balance of vaginal fluids. When oestrogen levels drop vaginal tissues become thinner, drier, and less elastic.

Oestrogen maintains the thick walls (epithelial layers) of the vagina as well as the levels of glycogen, which are used by good bacteria (Lactobacilli) for the healthy functioning of the vagina. A healthy vagina has a pH of between 4.0 to 4.5 but when oestrogen levels drop, the vagina becomes more alkaline (pH increases) which results in sub-optimal health in the vagina and sometimes also the urethra (pee hole).


What Causes Lower Oestrogen Levels?

Low oestrogen levels, which can cause vaginal atrophy, may be triggered by many factors, including:

  • Perimenopause (the years leading up to menopause)
  • Pelvic radiotherapy
  • Breastfeeding or childbirth
  • Chemotherapy or breast cancer treatment
  • Hormonal cancer treatments
  • Removal of both ovaries (surgical menopause)
  • Rarely, an underlying condition such as diabetes or Sjogren’s syndrome
  • Not having given birth vaginally, and smoking may also trigger early menopause.
  • Lack of sexual activity in older women, especially among women with no vaginal births, can impact general vaginal health.
  • Upsetting the vagina’s natural pH balance by using perfumed products or soaps in your intimate area can irritate the vagina tissues.
  • Some types of medication, such as antidepressants or oral contraceptives, can lower oestrogen levels.


How Is Vaginal Atrophy Diagnosed?

Vaginal atrophy is usually diagnosed by your GP (or nurse) based on your symptoms and a pelvic exam. During a pelvic exam, your doctor will look for signs of vaginal atrophy in your vagina and cervix. Your doctor may want to do further tests which could include a Pap Smear, urine test, ultrasound, vaginal pH test or vaginal infection test.

What Are The Symptoms Of Vaginal Atrophy?

It is estimated that over 50% of postmenopausal women fail to visit their doctor when experiencing symptoms of vaginal atrophy. This is perhaps due to embarrassment or ignorance regarding the symptoms and treatment options. Postmenopausal women who experience the following symptoms should consult their healthcare provider for a thorough appraisal:

  • Vaginal dryness
  • Redness and itching of the genitalia
  • Burning sensation in the vagina
  • Discharge with a foul odour
  • Burning sensation when urinating
  • Urgency with urination
  • Urinary incontinence (not being able to control your bladder)
  • Recurrent urinary tract infections (Chronic UTI)
  • Light bleeding
  • Painful intercourse (due to decreased lubrication during sexual activity)
  • Bleeding or discomfort after intercourse
  • Tightening and shortening of the vagina

How Is Vaginal Atrophy Treated?

Regrettably, most women do not seek medical help to treat their symptoms of vaginal atrophy. Ideally, women should seek medical help when the first signs of atrophy present themselves, and early treatment can prevent the progression of the condition.

The time it takes to treat symptoms of vaginal atrophy varies depending on what method you use and the severity of your condition. Your doctor can discuss all possible treatment options with you based on your medical background and symptoms. Treatment options may include:


Non-hormonal Treatments

Although oestrogen therapy may be the most effective, there are several treatment options available that do not involve hormones, namely:

  • Lubricants and moisturisers can treat vaginal dryness and improve comfort during sex. These products are usually water, silicone or oil-based and are very short-acting.
  • Vaginal moisturisers, applied every 1 – 3 days, stick to the vaginal walls to help the cells maintain moisture.
  • Some natural oils, such as olive and coconut oil, may also be used as lubricants and moisturisers.


Oestrogen Therapy

Oestrogen therapy is a very effective method of treating vaginal atrophy. Oestrogen treatment options include:

  • Topical oestrogen treats the symptoms of vaginal atrophy without increasing levels of oestrogen levels in your bloodstream. It is available in a cream, a vaginal pill or a ring.
  • Vaginal oestrogen cream is usually inserted into your vagina, 2-3 times per week, using an applicator.
  • The vaginal ring is a thin, flexible ring that is placed into your vagina every 3 months. It releases a low dose of oestrogen over the course of three months.
  • Vaginal tablets are inserted into your vagina using an applicator about 2-3 times per week.

Hormone Replacement Therapy

Also known as HRT, this systemic oestrogen therapy may be helpful for women who have other symptoms of menopause such as severe hot flashes. It is generally not recommended if you have been menopausal for longer than 10 years or only have vaginal dryness. In this case, topical oestrogen treatments might be more suitable.  


DHEA is a hormone precursor which is mostly available as a health supplement. Limited evidence suggests that it provides relief from menopausal symptoms, including decreased sex drive, diminished skin tone, and vaginal dryness. Doctors, however, remain reluctant to prescribe DHEA as there is a lack of evidence to support its safety or efficacy. 

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