Vaginal atrophy

WHAT IS IT?

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
• Breastfeeding.

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

SYMPTOMS

Common signs of vaginal atrophy include:

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

DIAGNOSIS

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.

PREVENTION

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.

TREATMENT

Treatments range from over-the-counter moisturizers to prescription-only hormone therapy. Women can often manage mild symptoms with nonhormonal moisturizers and, during sexual intercourse, vaginal lubricants. Sexual activity itself may improve the symptoms. If none of these approaches helps, you may need low-dose estrogen in the form of a cream, tablet, suppository or ring inserted into the vagina. Here’s how the various options work:

• Vaginal moisturizers. Water-based vaginal moisturizers adhere to the surface of the vagina, releasing water and producing a moist film over vaginal tissue. They also help restore vaginal pH. Moisturizers are a good choice if vaginal dryness is bothersome most of the time and not just during sexual activity.
• Vaginal lubricants. In addition to a moisturizer, you may want to use a lubricant during intercourse. You can apply it before intercourse to the vaginal opening or to the penis.
• Low-dose vaginal estrogen. Estrogen in any form — oral, transdermal (via skin patch), or vaginal — can help restore normal vaginal pH and beneficial bacteria, thicken the epithelium, increase vaginal secretions, and decrease vaginal dryness. But it’s best to apply the estrogen directly to the vagina. Compared with oral or transdermal estrogen, vaginal application requires a lower dose and involves less exposure of breast and endometrial tissues, where estrogen can increase the risk of cancer by stimulating the growth of cells. Low-dose estrogen products recommended specifically for the treatment of vaginal atrophy include vaginal creams, the vaginal tablets, vaginal suppositories, and vaginal rings (the ring that sits around the cervix and releases a very low, steady dose of estrogen).

WHEN TO CALL A PROFESSIONAL

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.

Source: HARVARD HEALTH PUBLISHING (Harvard Medical School)

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Additional information for this article: Stellapharm J.V. Co., Ltd. – Branch 1
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