Vaginal atrophy is a 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 becomes atrophic -- thin, dry and shrunken. 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
- 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.
Vaginal atrophy can be treated with estrogen therapy. The doctor may prescribe an estrogen pill, a topical estrogen cream, suppositories to insert in the vagina, an estrogen skin patch, or a vaginal estrogen ring. Estrogen cream or suppositories are inserted into the vagina using an applicator. An estrogen patch is applied once or twice a week to deliver estrogen through the skin. A vaginal ring is placed in the vagina for 3 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.
Until recently, estrogen had been thought to reduce the incidence of heart attack and stroke in postmenopausal women, but recent clinical trials, known as the Women's Health Initiative, have thrown doubt on that theory. This research shows that women actually may be more at risk of heart attack and stroke while using combined estrogen-progesterone therapy and at higher risk of stroke when using estrogen alone. Based on this study, the use of estrogen, in combination with progesterone or alone, is no longer recommended for the prevention of heart disease or stroke. 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 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
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
American Academy of Family Physicians (AAFP)
11400 Tomahawk Creek Parkway
Leawood, KS 66211-2672