Vaginal atrophy

Vaginal atrophy

Definition:

Vaginal atrophy (atrophic vaginitis) is thinning and inflammation of the vaginal walls due to a decline in estrogen. Vaginal atrophy occurs most often after menopause, but it can also develop during breast-feeding or at any other time your body's estrogen production declines.

For many women, vaginal atrophy makes intercourse painful — and if intercourse hurts, your interest in sex will naturally wane. In addition, healthy genital function is closely intertwined with healthy urinary system function.

Simple, effective treatments for vaginal atrophy are available. Reduced estrogen levels do result in changes to your body, but it doesn't mean you have to live with the discomfort associated with vaginal atrophy.

Symptoms:


With moderate to severe vaginal atrophy, you may experience the following vaginal and urinary signs and symptoms:

• Vaginal dryness
• Vaginal burning
• Burning with urination
• Urgency with urination
• More urinary tract infections
• Urinary incontinence
• Light bleeding after intercourse
• Discomfort with intercourse
• Shortening and tightening of the vaginal canal

When to see a doctor
By some estimates, about half of postmenopausal women experience vaginal atrophy, although few seek treatment. Many resign themselves to the symptoms or are embarrassed to broach the topic with their doctors.
Make an appointment to see your doctor if you experience painful intercourse that's not resolved by using a vaginal moisturizer (Replens, others) or water-based lubricant (Astroglide, K-Y, others), or if you have vaginal symptoms, such as unusual bleeding, discharge, burning or soreness.

Causes:


Vaginal atrophy is caused by a decrease in estrogen production. Less circulating estrogen makes your vaginal tissues thinner, drier, less elastic and more fragile.
A drop in estrogen levels and vaginal atrophy may occur:

• After menopause
• During the years leading up to menopause (perimenopause)
• During breast-feeding
• After surgical removal of both ovaries (surgical menopause)
• After pelvic radiation therapy for cancer
• After chemotherapy for cancer
• As a side effect of breast cancer hormonal treatment

Vaginal atrophy due to menopause may begin to bother you during the years leading up to menopause (perimenopause), or it may not become a problem until several years into menopause. Although the condition is common, not all menopausal women develop vaginal atrophy. Regular sexual activity helps you maintain healthy vaginal tissues.

Complications:


With vaginal atrophy, your risk of vaginal infections (vaginitis) increases. Atrophy leads to a change in the acidic environment of your vagina, making you more susceptible to infection with bacteria, yeast or other organisms.

Atrophic vaginal changes are associated with changes in your urinary system (genitourinary atrophy), which can contribute to urinary problems. You might experience increased frequency or urgency of urination or burning with urination. Some women experience more urinary tract infections or incontinence. Although stress incontinence is common among menopausal women, it doesn't appear to be caused by vaginal atrophy. The connection between estrogen deficiency and urinary problems remains unclear.

Treatments and drugs:

Mild symptoms of vaginal atrophy may be relieved by use of an over-the-counter lubricant or moisturizer.

If symptoms are bothersome, however, either topical (vaginal) or oral estrogen is effective in relieving vaginal dryness and itchiness, and improving vaginal elasticity. Vaginal estrogen has the advantage of being effective at lower doses and limiting your overall exposure to estrogen. Estrogen applied to the vagina can still result in estrogen reaching your bloodstream, but the amount is minimal. Vaginal estrogen may also provide more direct relief of symptoms.

You should experience noticeable improvements after a few weeks of estrogen therapy. Some symptoms of severe atrophy may take longer to resolve.
If you have a history of breast cancer, oral estrogen therapy generally isn't recommended as it might stimulate cancer cell growth, especially if your breast cancer was hormonally sensitive.

Whether low-dose vaginal estrogen is safe for breast cancer survivors is controversial. It's not known whether even a small increase in the level of estrogen circulating in your bloodstream may increase your risk of the cancer coming back. You might choose nonhormonal treatments, such as moisturizers and lubricants, instead.

Topical estrogen
Vaginal estrogen therapy comes in several forms. Because they all seem to work equally well, you and your doctor can determine which one is best suited to your preferences.

• Vaginal estrogen cream (Estrace, Premarin, others). You insert this cream directly into your vagina with an applicator, usually at bedtime. Your doctor will let you know how much cream to use and how often to insert it, usually a daily application for the first few weeks and then two or three times a week thereafter. Although creams may offer more immediate relief than do other forms of vaginal estrogen, they can be more messy.
• Vaginal estrogen ring (Estring). A soft, flexible ring is inserted into the upper part of the vagina by you or your doctor. The ring releases a consistent dose of estrogen while in place and needs to be replaced about every three months. Many women like the convenience this offers.
• Vaginal estrogen tablet (Vagifem). You use a disposable applicator to place a vaginal estrogen tablet in your vagina. Your doctor will let you know how often to insert the tablet; you might, for instance, use it daily for the first two weeks and then twice a week thereafter.

Oral estrogen therapy
If vaginal dryness is associated with other symptoms of menopause, such as moderate or severe hot flashes, your doctor may suggest estrogen pills, patches or gel, or a higher dose estrogen ring along with a progestin. Progestin is usually given as a pill, but combination estrogen-progestin patches also are available. Talk to your doctor to decide if hormone treatment is an option and, if so, which type is best for you.