Atrophic vaginitis affects 47% of postmenopausal women and is caused by low levels of estrogen. Symptoms may include vaginal dryness, itching, or burning. Treatments may include lubricants, lifestyle changes as well as estrogen therapy.
What is atrophic vaginitis?
Atrophic vaginitis is a common condition that may affect up to 47% of postmenopausal women. It occurs due to low levels of estrogen which can be caused by menopause, medical treatments, and hormonal conditions, among other things.
Symptoms of atrophic vaginitis include vaginal dryness or irritation, especially during sexual activity, vaginal bleeding, vaginal discharge, and changes in urination.
Treatments for atrophic vaginitis include lubricants and lifestyle changes to increase comfort and improve sexual performance, as well as hormonal treatments to address the underlying cause of the condition.
You should speak with your physician to discuss symptoms and treatment options. Treatment may include estrogen replacement, moisturizers, and lubricants.
Atrophic vaginitis symptoms
Symptoms of vaginal discomfort may occur, as well as bleeding and discharge and urinary-related issues.
Vaginal discomfort and pain
Initially women with atrophic vaginitis may experience these symptoms only during or after sexual activity, but gradually the symptoms may occur during daily activities. This includes:
- Irritation or itching
- Decreased vaginal lubrication during sexual intercourse: This is one of the earliest symptoms and may increase in severity, leading to pain.
- : As a result, some women with atrophic vaginitis may avoid having sexual intercourse.
Bleeding and discharge
- Varied occurrence: Bleeding may be due to minor trauma and/or during sexual intercourse, or in more severe cases, may occur spontaneously with daily activities.
- Discharge from the vagina: This discharge may be white or yellow and may have a foul odor.
The following can occur because the urinary system also responds to estrogen levels in the body, and low estrogen levels can have a negative effect. Symptoms include:
Atrophic vaginitis causes
Atrophic vaginitis is a condition in which the vaginal area becomes dry and inflamed due to low levels of estrogen. Estrogen normally maintains normal blood flow to the vagina, thickening the lining of the vagina and keeping the surface of the vagina moist. Common causes of decreased estrogen and development of atrophic vaginitis include menopause, removal of the ovaries, chemotherapy or radiation, ovarian dysfunction, taking certain medications that can block estrogen, giving birth, and having a hormonal disorder.
Going through is the most common reason that women develop atrophic vaginitis. When women go through menopause, the level of estrogen they produce decreases by about 95 percent. In addition, estrogen levels normally fall with age, exacerbating the low estrogen levels.
Removal of the ovaries
Having both ovaries removed, such as to treat or prevent the development of ovarian cancer, dramatically decreases a woman's estrogen level and may lead to atrophic vaginitis. The ovaries are a main source of estrogen, so removing one or both ovaries through a surgery called oophorectomy reduces the estrogen level.
Chemotherapy or radiation
Having chemotherapy or radiation therapy to treat cancer in the pelvic area can damage the ovaries, decreasing the ability to produce estrogen and potentially leading to atrophic vaginitis.
Having a condition in which the ovaries stop functioning called primary ovarian insufficiency or premature ovarian failure causes ovaries to stop functioning before the age of 40. When this occurs, estrogen levels drop, as they do in menopause. Because of the low estrogen levels, women with this condition are likely to develop atrophic vaginitis.
Taking certain medications that block estrogen effects
Certain medications can block or inhibit estrogen, potentially leading to atrophic vaginitis. These include:
- Contraceptives: Such as medroxyprogesterone acetate (Provera)
- For certain uterine conditions: Such as danazol (Cyclomen) or leuprolide (Lupron)
- For breast cancer: Such as tamoxifen (Soltamox), among others
Right after giving birth, women develop decreased estrogen levels due to hormonal changes in the body. Lactation can also decrease estrogen levels, further exacerbating the problem.
Certain hormonal disorders can lower the levels of estrogen in the body and lead to atrophic vaginitis. These disorders usually involve the hypothalamus and/or the pituitary gland, which are in the brain and normally release hormones that trigger the ovaries to release estrogen.
Treatment options and prevention for atrophic vaginitis
Treatments may involve a combination of over-the-counter medication, medication from a medical provider, as well as lifestyle adjustments. Treatment options include moisturizers and lubricants, increased sexual activity, vaginal estrogen therapy, and oral medication to boost the effects of estrogen in the vagina.
Vaginal moisturizing medications and lubricants
- Me Again
- Vagisil Feminine Moisturizer
- K-Y SILK-E
Sexual intercourse or masturbation
Increasing these activities may decrease symptoms of vaginal atrophy due to increased stretching of the vaginal tissue or improving blood flow. Some women may not be able to tolerate sexual intercourse due to pain or irritation. However, women who do not have substantial pain during sexual intercourse may experience an improvement in their symptoms by increasing sexual intercourse or masturbation.
Vaginal estrogen therapy
Using estrogen therapy may benefit women with atrophic vaginitis who do not obtain sufficient symptom relief from vaginal moisturizing medications and lubricants. Applying estrogen to the vagina may help alleviate symptoms without systemic side effects. There are many forms of vaginal estrogen therapy, such as:
- A tablet placed in the vagina (Vagifem)
- A ring placed in the vagina (Estring)
- applied to the vagina (Premarin, Estrace)
Oral medication to boost estrogen
Taking medication to increase the effect of estrogen in the vagina may benefit women with atrophic vaginitis who do not respond to other treatments. The medication, called , is taken as a pill and works only on the vagina, so there is a low risk of side effects.
When to seek further consultation for atrophic vaginitis
If you develop any symptoms of atrophic vaginitis, such as vaginal dryness or irritation, pain with sexual intercourse, or bleeding from the vagina, you should see your physician. He or she can evaluate you to determine if you have atrophic vaginitis, then offer the appropriate treatment.
- Mayo Clinic Staff. Vaginal atrophy. The Mayo Clinic. . Published April 24, 2010.
- Bachman GA,Nevadunsky N. Diagnosis and treatment of atrophic vaginitis. Am Fam Physician. . 2000;61(10):3090-3096.
- Vaginal Atrophy Atrophic Vaginitis. Harvard Health Publishing. . Published September 2013.
- Atrophic vaginitis can cause itching, burning, and sexual discomfort but treatments are available. Harvard Health Publishing. . Updated January 20, 2017.
- Mac Bride MB, Rhodes DJ, Shuster LT. Vulvovaginal Atrophy. Mayo Clinic Proceedings. 2010;85(1):87-94. doi:10.4065/mcp.2009.0413. .
- Bachmann G, Santen J.Patient education: Vaginal dryness (Beyond the Basics). UpToDate. . Updated Dec.12, 2016
- Vaginal Atrophy. Cleveland Clinic. . Updated June 13, 2014.
- Lee A, Kim TH, Lee HH, et al. Therapeutic Approaches to Atrophic Vaginitis in Postmenopausal Women: A Systematic Review with a Network Meta-analysis of Randomized Controlled Trials. J Menopausal Med. 2018;24(1):1-10. doi:10.6118/jmm.2018.24.1.1. .
- Shin JJ, Kim SK, Lee JR, Suh CS. Ospemifene: A Novel Option for the Treatment of Vulvovaginal Atrophy. J Menopausal Med.2017;23(2):79-84. doi:10.6118/jmm.2017.23.2.79.