Vaginal Atrophy 101

What is vaginal atrophy?

Vaginal atrophy, also known as the genitourinary syndrome of menopause, is very common. It affects 50-80% of women, and the symptoms can start before the stop of your periods. Interestingly, it can also occur in women who experience decreased estrogen levels due to other reasons, such as breastfeeding or certain medications.

Estrogen plays a crucial role in maintaining the health of the vagina, bladder, and urethra. When estrogen levels decline, it can lead to distressing symptoms.

Commonly reported symptoms of vaginal atrophy include:

• Irritation of the vulva
• Reduced vaginal lubrication
• Burning
• Pain with urination
• Painful sex
• Vaginal discharge

Other signs of vaginal atrophy include:

• Vaginal dryness
• Urgency to pee
• Elevated vaginal pH
• Labial atrophy
• Shortening of the vaginal canal
• Clitoral atrophy

Vaginal atrophy also increases the likelihood of other symptoms:

• Recurrent UTIs
• Bleeding with or after sex
• Absence of sexual activity

Severe signs include:

• Bleeding under the skin (petechiae)
• Urethral changes such as caruncles, prolapse, or polyps
• Tearing or bleeding from a routine pelvic exam

Despite the prevalence of vaginal atrophy, many women do not seek help due to embarrassment or lack of awareness of treatment options.

Vaginal atrophy is considered a chronic and progressive condition - meaning it does not typically get better on its own.

Leading medical organizations, including the American College of Obstetricians and Gynecologists (ACOG) and the North American Menopause Society (NAMS), provide guidelines for the management of vaginal atrophy.

One of the most effective treatments is topical vaginal estrogen, which can be used in different forms - including a vaginal cream, ring, or tablet. Interestingly, topical vaginal estrogens can be a safer option than systemic estrogen which is taken orally or applied as a patch. Non-hormonal moisturizers and lubricants can also help relieve symptoms.