January 4, 2013
Dear Mayo Clinic:
What exactly is vaginal atrophy? Are there any effective treatments for it, or is it just another part of aging that I will have to live with?
Vaginal atrophy (atrophic vaginitis) is the thinning and inflammation of the vaginal walls and lower urinary tract due to a lack of estrogen. The condition typically occurs in perimenopausal or menopausal women and can cause vaginal itching and discomfort during intercourse. By some estimates, about half of postmenopausal women experience vaginal atrophy. Though some women do not seek help, there are a number of treatment options for vaginal atrophy that can offer relief.
With vaginal atrophy, lower levels of estrogen make the vaginal tissues thinner, drier, less elastic and more fragile. The condition can develop anytime a woman's estrogen production declines, including the years leading up to and after menopause, after childbirth, during breast-feeding, after the surgical removal of both ovaries, after pelvic radiation or chemotherapy for cancer, or as a side effect of breast cancer hormonal treatment.
The symptoms of vaginal atrophy can vary from moderate to severe, and might include dryness, burning, discomfort during intercourse and light bleeding after intercourse. Burning with urination, urgency with urination, urinary incontinence and frequent urinary tract infections also might occur. The thinning of the vaginal walls and changes in the acidity of the vagina caused by vaginal atrophy also can increase the risk of vaginal infections.
Symptoms of vaginal atrophy might be more intense if you smoke, if you've stopped having intercourse for a prolonged time and resume it again, if you've had vaginal surgery, or if you've never given birth vaginally.
Your doctor can diagnose vaginal atrophy by performing a pelvic exam and, if you have urinary symptoms, by ordering a urinalysis to rule out any other possible conditions, such as a urinary tract infection.
For mild vaginal dryness or irritation, regularly applying a nonprescription vaginal moisturizer (Me Again, Replens, Silk-E, others) can restore some moisture to the vaginal area. A nonprescription water-based lubricant (Astroglide, K-Y, others) can reduce friction and discomfort during intercourse. Try different products to find a treatment that suits your needs. If you use condoms or a diaphragm, avoid oil-based lubricant products, which can damage these types of contraceptives.
Sexual activity also can ease the symptoms associated with vaginal atrophy. This is likely a result of enhanced blood flow to the vagina, which helps keep vaginal tissues healthy. If vaginal intercourse is painful, give yourself plenty of time to become aroused and consider use of a personal lubricant.
For moderate or severe symptoms, topical (vaginal) or systemic (oral, transdermal or higher dose vaginal application) estrogen can relieve vaginal dryness and itchiness and improve vaginal tissue elasticity. However, your doctor might caution against use of systemic estrogen if you have a history of breast cancer or other hormonally sensitive cancers.
If estrogen therapy is an option for you, expect noticeable improvements after a few weeks of use. Severe symptoms might take months to improve. Side effects of estrogen therapy, while uncommon, might include vaginal bleeding or spotting or breast tenderness. Hormone therapy can also cause nausea, bloating, headaches, dizziness and mood changes although these side effects generally occur mainly with systemic use of hormone therapy. Ask your doctor what to expect.
Topical estrogen is more effective than systemic estrogen at treating vaginal atrophy and limiting your overall exposure to estrogen. Estrogen applied to the vagina can still result in estrogen reaching your bloodstream, but the amount is significantly lower than with systemic estrogen treatment. Generally it appears safe to use small amounts of vaginal estrogen in women with a history of breast cancer. Vaginal estrogen therapy comes in several forms.
Although symptoms of vaginal atrophy can be frustrating, one of these treatment options may work for you. Talk to your doctor to determine which type of treatment is best for your circumstances.
— Mary Marnach, M.D., Obstetrics and Gynecology, Mayo Clinic, Rochester, Minn.