Vaginal Atrophy Treatment

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Vaginal Atrophy Treatment: Causes, Symptoms & Diagnosis - A common condition that generally affects women following menopause.

Vaginal Atrophy

Vaginal atrophy is a common condition that generally affects women following menopause. In this article, you will learn vaginal atrophy treatment, causes, symptoms, diagnosis and some self care. The symptoms and signs of genitourinary syndrome of menopause (GSM) result from lower levels or absence of (vaginal) estrogen.

These changes can include: the loss of sensation on your labia, decreased lubrication leading up to sex and other vaginal symptoms, including changes to the vagina, urethra, and bladder.

If vaginal atrophy is seriously affecting your everyday life, you can seek medical advice from your GP or gynaecologist, who can make a proper diagnosis after a quick and simple examination of the vaginal area and provide the recommended vaginal atrophy treatment. 

Vaginal Atrophy Causes

Vaginal atrophy can occur at any age, although one main cause is reduced estrogen production in the ovaries during menopause. Estrogen is the hormone responsible for female sexual development and menstrual regularity. It helps promote bone and skin health and supports other tissues in the body.

Estrogen can also determine brain activity and mood. Women with premenopause alongside other medical conditions that reduce the levels of estrogen in the body can also develop vaginal atrophy. The following factors can reduce estrogen levels:

  • certain types of contraceptives, including the contraceptive injection and the combined pill
  • a lack of arousal before intercourse leading to nonproduction of a woman’s natural lubricant
  • breastfeeding or childbirth
  • hormonal cancer treatments, chemotherapy, and radiotherapy to the pelvic area
  • diabetes
  • Sjögren’s syndrome, in which the immune system attacks fluid-producing glands in the body

Diagnosis

Diagnosis of genitourinary syndrome of menopause (GSM) may involve:

  • Pelvic exam, during which your doctor feels your pelvic organs and visually examines your external genitalia, vagina and cervix.
  • Urine test, which involves collecting and testing your urine, if you have urinary symptoms.
  • Acid balance test, which involves taking a sample of vaginal fluids or placing a paper indicator strip in your vagina to test its acid balance.

Pelvic exam

In a pelvic exam, your health care provider inserts two gloved fingers inside your vagina. Pressing down on your abdomen at the same time, your provider can examine your uterus, ovaries and other organs.

And once diagnosed with atrophic vaginitis, the healthcare professional can help you decide on the best treatment option based on severity, age and other lifestyle factors.

Symptoms of Vaginal Atrophy

For many women, vaginal atrophy not only makes intercourse painful but also leads to distressing urinary symptoms. Because the condition causes both vaginal and urinary symptoms, doctors use the term “genitourinary syndrome of menopause (GSM)” to describe vaginal atrophy and its accompanying symptoms.

Genitourinary syndrome of menopause (GSM) signs and symptoms may include:

  • Vaginal dryness
  • Vaginal burning
  • Genital itching
  • Vaginal discharge
  • Burning with urination
  • Urgency with urination
  • Frequent urination
  • Recurrent urinary tract infections
  • Urinary incontinence
  • Light bleeding after intercourse
  • Discomfort with intercourse
  • Decreased vaginal lubrication during sexual activity
  • Shortening and tightening of the vaginal canal

Vaginal Atrophy Treatment

There are several treatments for women suffering from vaginal atrophy, which typically causes vaginal dryness, itching and redness, as well as discomfort during intercourse. To treat genitourinary syndrome of menopause, your doctor may first recommend over-the-counter treatment options, including:

  • Vaginal moisturizers. Try a vaginal moisturizer (K-Y Liquibeads, Replens, Sliquid, others) to restore some moisture to your vaginal area. You may have to apply the moisturizer every few days. The effects of a moisturizer generally last a bit longer than those of a lubricant.
  • Water-based lubricants. These lubricants (Astroglide, K-Y Jelly, Sliquid, others) are applied just before sexual activity and can reduce discomfort during intercourse. Choose products that don’t contain glycerin or warming properties because women who are sensitive to these substances may experience irritation. Avoid petroleum jelly or other petroleum-based products for lubrication if you’re also using condoms, because petroleum can break down latex condoms on contact.

If those options don’t ease your symptoms, your doctor may recommend:

Topical estrogen

Vaginal estrogen has the advantage of being effective at lower doses and limiting your overall exposure to estrogen because less reaches your bloodstream. It may also provide better direct relief of symptoms than oral estrogen does.

Vaginal estrogen therapy comes in a number of forms. Because they all seem to work equally well, you and your doctor can decide which one is best for you.

  • Vaginal estrogen cream (Estrace, Premarin). You insert this cream directly into your vagina with an applicator, usually at bedtime. Typically women use it daily for one to three weeks and then one to three times a week thereafter, but your doctor will let you know how much cream to use and how often to insert it.
  • Vaginal estrogen suppositories (Imvexxy). These low-dose estrogen suppositories are inserted about 2 inches into the vaginal canal daily for weeks. Then, the suppositories only need to be inserted twice a week.
  • Vaginal estrogen ring (Estring, Femring). You or your doctor inserts a soft, flexible ring into the upper part of the vagina. 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. A different, higher dose ring is considered a systemic rather than topical treatment.
  • 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.

Ospemifene (Osphena)

Taken daily, this pill can help relieve painful sex symptoms in women with moderate to severe genitourinary syndrome of menopause (GSM). It is not approved in women who’ve had breast cancer or who have a high risk of developing breast cancer.

Prasterone (Intrarosa)

These vaginal inserts deliver the hormone DHEA directly to the vagina to help ease painful sex. DHEA is a hormone that helps the body produce other hormones, including estrogen. Prasterone is used nightly for moderate to severe vaginal atrophy.

Systemic 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. Estrogen taken by mouth enters your entire system. Ask your doctor to explain the risks versus the benefits of oral estrogen, and whether or not you would also need to take another hormone called progestin along with estrogen.

Hormone Replacement Therapy (HRT)

HRT or systemic estrogen therapy involves taking medication to replace the hormones which have been lost during menopause. HRT can be prescribed by your GP and can be taken in several forms including tablets, gels, patches or implants. This type of estrogen therapy supplies oestrogen to the entire body.

HRT will have a stronger effect on the body than vaginal oestrogen, so it is recommended if you have some other symptoms related to menopause, such as hot flushes. However, it is important to note that HRT has several risk factors and side effects, like vaginal or urinary symptoms, which may deter many women from going ahead with this type of treatment for their vaginal atrophy.

Vaginal dilators

You may use vaginal dilators as a nonhormonal treatment option. Vaginal dilators may also be used in addition to estrogen therapy. These devices stimulate and stretch the vaginal muscles to reverse narrowing of the vagina.

If painful sex is a concern, vaginal dilators may relieve vaginal discomfort by stretching the vagina. They are available without a prescription, but if your symptoms are severe, your doctor may recommend pelvic floor physical therapy and vaginal dilators. Your health care provider or a pelvic physical therapist can teach you how to use vaginal dilators.

Topical lidocaine

Available as a prescription ointment or gel, topical lidocaine can be used to lessen discomfort associated with sexual activity. Apply it five to 10 minutes before you begin sexual activity.

If you’ve had breast cancer

If you have a history of breast cancer, tell your doctor and consider these options:

  • Nonhormonal treatments. Try moisturizers and lubricants as a first choice.
  • Vaginal dilators. Vaginal dilators are a nonhormonal option that can stimulate and stretch the vaginal muscles. This helps to reverse narrowing of the vagina.
  • Vaginal estrogen. In consultation with your cancer specialist (oncologist), your doctor might recommend low-dose vaginal estrogen if nonhormonal treatments don’t help your symptoms. However, there’s some concern that vaginal estrogen might increase your risk of the cancer coming back, especially if your breast cancer was hormonally sensitive.
  • Systemic estrogen therapy. Systemic estrogen treatment generally isn’t recommended, especially if your breast cancer was hormonally sensitive.

Vaginal Atrophy Natural Remedies

There are several lifestyle changes that could help women relieve the symptoms of vaginal atrophy.

  • Giving up smoking: Smoking decreases estrogen levels and increases the risk of developing vaginal atrophy, as well as other conditions, such as osteoporosis.
  • Staying sexually active: Sexual activity increases the flow of blood to the genitals, which in turn helps keep them healthy.
  • Avoiding perfumed products: This includes powders, soaps, and deodorants. It is important to note that certain perfumed lubricants and spermicides can also irritate the vagina and cause dryness.
  • Exercise: Regular exercise and physical activity aid hormone balance.
  • Keeping well hydrated: This can help maintain moisture levels in the body.

Diet and vaginal atrophy

At present, scientific research provides little evidence to support any claims that dietary changes can help women with vaginal atrophy. People with vaginal atrophy should discuss any herbal supplements or dietary changes with their doctor before making any long-term lifestyle changes to manage a condition.

Natural lubricants

Some natural lubricants might help soothe and lubricate the genital area. These include:

  • jojoba
  • coconut oil
  • aloe vera
  • vitamin E suppositories, which stimulate the vaginal mucosa that lubricate the vagina, as well as helping prevent infections

Complementary treatments

Probiotics are bacteria that have a positive effect on the human body. Limited research on 87 women suggests that probiotics might help relieve the symptoms of vaginal atrophy.

Some women with vaginal atrophy might also develop urinary problems, and probiotics might also be helpful in managing vaginal dryness. Further research is required to confirm the benefits of probiotics.

Vaginal Atrophy Natural Treatment

As well as natural remedies and lifestyle changes, there are several medications for treating vaginal atrophy. Many of the following options are available over the counter (OTC):

  • Water-based, glycerine-free lubricants help reduce discomfort during sex.
  • Apply water-based vaginal moisturizers every 2 to 3 days. Their effect lasts longer than a lubricant.
  • Applying topical estrogen cream directly to the vagina relieves symptoms quickly and effectively. It also reduces the exposure of the bloodstream to estrogen.
  • Oral estrogen is also an option.
  • An estrogen-releasing ring can remain in the vagina and release hormones to address the changes.
  • Systemic estrogen therapy is available as a skin patch, an implant under the skin, tablets, or a topical gel.

Systemic estrogen therapy has some potential side effects. These include:

  • breast tenderness
  • headaches
  • nausea
  • indigestion
  • stomach pain
  • vaginal bleeding

There might also be a slightly increased risk of developing blood clots and breast cancer with this type of treatment. However, the benefits usually outweigh the risks.

Self Care

If you’re experiencing vaginal dryness or irritation, you may find relief if you:

  • Try an over-the-counter moisturizer. Examples include K-Y Liquibeads, Replens and Sliquid. This can restore some moisture to your vaginal area.
  • Use an over-the-counter water-based lubricant. A lubricant can reduce discomfort during intercourse. Examples include Astroglide, K-Y Jelly and Sliquid.
  • Allow time to become aroused during intercourse. The vaginal lubrication that results from sexual arousal can help reduce symptoms of dryness or burning.

Alternative medicine

Some alternative medicines are used to treat vaginal dryness and irritation associated with menopause, but few approaches are backed by sufficient evidence from clinical trials. Interest in complementary and alternative medicine is growing, and researchers are working to determine the benefits and risks of various alternative treatments for genitourinary syndrome of menopause.

Talk with your doctor before taking any herbal or dietary supplements for perimenopausal or menopausal symptoms. The Food and Drug Administration doesn’t regulate herbal products, and some may interact with other medications you take, putting your health at risk.

Can Vaginal Atrophy be Reversed?

While vaginal atrophy isn’t fully reversible, a range of home and medical treatments, including estrogen therapy, can provide relief. Many women experience vaginal atrophy during and after menopause.

This condition, sometimes called vulvovaginal atrophy (VVA), causes vaginal:

  • thinness
  • dryness
  • inflammation
  • pain

VVA occurs when estrogen levels drop, as they do around the time a woman begins menopause. When estrogen levels fall, the symptoms of VVA may become more severe. Atrophy may also cause urinary problems and pain during intercourse. Urinary problems may include:

  • burning and stinging while urinating
  • feeling the need to urinate more frequently
  • urinary leakage

These urinary issues almost always accompany vaginal atrophy symptoms. For that reason, these conditions are collectively known as genitourinary syndrome of menopause (GSM). Effective treatments for both VVA and GSM are available.

Vaginal Atrophy Bleeding

Around 50% of women experience symptoms of vaginal atrophy when the cells in the vagina are most lacking in hydration and cervix lubrication decreases. The symptoms can include vaginal discomfort or soreness, burning sensation, itching and bleeding. It can also lead to urinary tract issues like recurrent cystitis.

vaginal dryness (atrophic vaginitis) caused by reduced vaginal secretions after the menopause. damage to the vagina, such as tears caused by childbirth, or by dryness or friction during sex.

Bladder Atrophy Symptoms

Menopause urinary symptoms: Symptoms associated with urogenital atrophy can range from minor inconveniences to emotional distress. Unlike other symptoms of menopause, such as hot flashes, urogenital atrophy symptoms can become worse as the woman ages.

Symptoms related to urinary atrophy are:

  • Stress incontinence: the leaking of urine due to the stress of laughing, coughing or sudden movement
  • Urge incontinence (irritable/overactive bladder): the sudden, strong urge to urinate, which can result in a loss of bladder control before one can reach a bathroom
  • An increased frequency in the need to urinate
  • Waking up several times during the night to urinate (nocturia).

Symptoms related to vaginal atrophy are:

  • A reduction in the fullness of the vulva and the vagina
  • Dryness, itching and burning in the vagina or on the vulva
  • Pain during sexual intercourse
  • Vaginal bleeding
  • An increase in urinary tract infections due to a change in the acidity of the vagina.

Urinary symptoms of pelvic organ prolapse are urge incontinence and painful urination.

When to See your Doctor

Vaginal atrophy is a highly personal condition, and women might feel embarrassment when discussing symptoms with a doctor. However, this hesitation can prevent an individual from seeking the treatment they need. The condition is very common, and treatment can yield good results.

Women experiencing the following should seek medical attention:

  • Symptoms are severe and interfering with daily function.
  • Sexual intercourse is painful, and vaginal lubricants do not provide relief.
  • There is bleeding, burning, or discharge from the vagina.
  • Accompanying symptoms occur, such as night sweats and hot flushes.

Effective natural and medical management of vaginal atrophy means that a woman can resume with a good quality of life.

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