Vaginal atrophy is change of the vagina that develops when there is a significant decrease in levels of the female hormone estrogen. The condition also is called atrophic vaginitis. Estrogen, which is produced by the ovaries, plays a vital role in keeping vaginal tissues lubricated and healthy. When levels of estrogen are low, vaginal tissue loses elasticity and becomes thin and dry. The capacity of the vaginal cavity may decrease. The vagina may become more prone to inflammation in an atrophic state. Common conditions with low estrogen levels that cause vaginal atrophy include:

• Menopause, when normal, age-related body changes cause the ovaries to decrease their production of estrogen
• Breastfeeding
• Surgical removal of the ovaries before the age of natural menopause, which can be done at the same time as a hysterectomy (removal of the uterus)
• Treatment with medications used to decrease estrogen levels in women who have conditions such as uterine fibroids or endometriosis
• Premature menopause, which occurs before age 40, a younger age than is considered normal for the average woman.

Vaginal atrophy typically develops so slowly that a woman may not notice any symptoms until five to ten years after menopause begins.

Common signs of vaginal atrophy include:

• Vaginal dryness
• Vaginal itch or a burning sensation
• Painful sexual intercourse
• Light bleeding after intercourse

If you are a middle-aged woman, your doctor will ask whether you have started menopause or whether you have been experiencing menopausal symptoms (absent or irregular menstrual periods, mood swings, hot flashes, difficulty sleeping at night, night sweats). If you are a woman of childbearing age, your doctor will inquire whether you are breastfeeding or having irregular menstrual periods, which could be caused by low estrogen levels or by an imbalance in female hormones. Your doctor also will review your medical and surgical history and ask about your current medications.

The doctor may suspect vaginal atrophy based on your age, symptoms and medical history. To confirm the diagnosis, the doctor will perform a pelvic examination to examine your vulva and vagina for signs of dryness, redness and thinning of tissue. If you are menopausal and have bleeding after intercourse, your doctor may want to check for endometrial cancer (cancer of the uterine lining) by doing an endometrial biopsy. In this procedure, a small piece of tissue is removed from the uterine lining, and is examined in a laboratory. The doctor also may want to check for a problem with the cervix by doing a Pap test.

The condition will continue until it is treated or estrogen levels return to normal.

A water-soluble vaginal lubricant can be used to moisten the tissues and prevent painful sexual intercourse. Regular sexual activity also can help to prevent symptoms. This is because sexual intercourse improves blood circulation to the vagina, which helps to maintain vaginal tissue and helps to keep the tissues supple.

Vaginal atrophy can be treated with estrogen therapy. The doctor may prescribe an estrogen pill or estrogen skin patch. An estrogen patch is applied once or twice a week to deliver estrogen through the skin. Pills and skin patch preparations deliver estrogen to the vaginal tissues through the blood stream, which exposes the whole body to estrogen.

Alternatively, a woman can use a vaginal preparation, such as a topical estrogen cream, an estrogen suppository or a vaginal estrogen ring. These estrogen preparations deliver estrogen directly to the vaginal tissues. Estrogen cream or suppositories are inserted into the vagina using an applicator. A vaginal ring is placed in the vagina for three months and slowly releases estrogen directly to the vaginal tissues.

Women also may use water-soluble lubricants for comfort. Water-soluble lubricants do not contain estrogen and can be purchased without prescription at drug stores, pharmacies or grocery stores.

The clinical trial known as the Women's Health Initiative showed that long-term use of estrogen after menopause increases the risk of breast cancer and possibly stroke. It also showed that older women may be more at risk of heart attack and stroke while using combined estrogen-progesterone therapy. However, estrogen is still recommended for the temporary relief of symptoms associated with menopause, such as vaginal atrophy. Doctors will try to use the lowest dose possible for the shortest time to relieve symptoms. Use of vaginal estrogen preparations causes very low levels of estrogen in the blood and thus is the safest way to treat vaginal atrophy with estrogen.

Women who still have a uterus and use estrogens should be aware that they can experience bleeding, which can be similar to a regular menstrual cycle. You should talk with your doctor about any bleeding you experience.

Women who have the following problems should not take estrogen:

• Unexplained vaginal bleeding
• Chronic or active liver disease
• Breast cancer
• Endometrial cancer
• Recent blood clots or a history of blood clots

In addition, women with migraine headaches, gallbladder disease, high blood pressure or endometriosis may not be candidates for estrogen therapy. If you have these problems, you should discuss the issue with your doctor.

Women who cannot use estrogen may use a water-soluble vaginal lubricant as needed to relieve vaginal dryness and moisten tissue.

Schedule an appointment with your doctor if you experience any vaginal bleeding, vaginal dryness, burning or itching, or if painful sexual intercourse is not relieved with a water-soluble lubricant.

In most people, the outlook is excellent.

American College of Obstetricians and Gynecologists
P.O. Box 96920
Washington, DC 20090-6920
Phone: 202-638-5577
http://www.acog.org/

American Academy of Family Physicians (AAFP)
http://www.familydoctor.org/