What is Postmenopausal Atrophic Vaginitis?

Also known as vaginal atrophy, postmenopausal atrophic vaginitis is the thinning of vaginal walls resulting from low estrogen levels. Mostly, it develops after menopause.

Menopause is when a woman is at the ages of between 45 and 55, a time when she cannot release eggs from her ovaries. Menstruation also stops at this time. You are considered postmenopausal if you have not menstruated for one year and above.

Women who develop vaginal atrophy have a higher risk of developing urinary function issues and chronic vaginal infections. The condition also results in painful sex.

According to studies, approximately 40% of women who are postmenopausal have atrophic vaginitis.

 

Vaginal atrophy symptoms

Although vaginal atrophy is common, only a small number of women go to their doctors to seek medical treatment.

For certain women, the symptoms may develop at the time of menopause or the time prior to the menopause. For others, symptoms only appear years later.

The symptoms are:

• Tightening and shortening of the vaginal canal
• Thinning of the walls of the vagina
• Involuntary leakage (urinary incontinence)
• Blood spotting after sex
• Vaginal dryness (lack of vaginal moisture)
• Pain or discomfort during sex
• Inflammation (vaginal burning)
• Burning or pain during urination
• Recurring urinary tract infections

 

What causes vaginal atrophy?

A decrease in estrogen is what leads to vaginal atrophy. When there is no estrogen, the tissues of the vagina become thin, and they dry out. The vagina loses its elasticity, becomes more fragile, and becomes more prone to injury.

Apart from menopause, estrogen can also decline during the following times:

• Surgical menopause (removal of ovaries)
• After hormonal therapy for breast cancer treatment
• After chemotherapy for cancer treatment
• During breastfeeding
• After pelvic radiation therapy for cancer treatment

You can keep the tissues of the vagina healthy by having regular intercourse. A sex life that is healthy is also beneficial to the circulatory system and improves the health of your heart.

 

Risk factors

Certain women have a higher risk of atrophic vaginitis than others. Women who never delivered their babies vaginally have an increased risk for vaginal atrophy compared to women who gave birth vaginally.

Smoking damages the circulation of blood, making the vagina and other tissues not get sufficient oxygen. When the flow of blood decreases, tissue thinning takes place. People who smoke also respond less to estrogen therapy in the form of a pill.

 

Possible complications

Vaginal atrophy makes you prone to vaginal infections. The condition alters the vaginal acidity, enabling yeast, bacteria, and other organisms to develop.

Vaginal atrophy increases your chances of getting genitourinary atrophy (urinary system atrophy). Symptoms linked with this condition include a burning feeling when urinating or frequent urination that is urgent in nature.

 

Diagnosis

If you experience pain during intercourse even with the use of lubrication, immediately visit your doctor. Also seek medical attention if you have soreness, vaginal bleeding that is unusual, burning or unusual discharge.

Certain women may feel embarrassed to discuss this personal problem with their doctors. To avoid possible complications, it is crucial to seek medical advice.

The doctor will inquire about the history of your health. They will ask you at what time your menstruation stopped and if you have ever suffered from cancer. Your doctor will want to know if you use any over-the-counter products. . Certain soaps, perfumes, lubricants, deodorants, spermicides, and bath products can worsen the sexual organs that are sensitive.

Your physician may recommend you to a gynecologist for physical evaluation and tests. In a pelvic exam, the doctor will palpate your pelvic organs. They will also look at your external genitalia for atrophy signs, such as:

• Sparse pubic hair
• Vaginal lining that is shiny, pale, and smooth
• External genitalia that is smooth and thin
• Bulges on the vagina walls (pelvic organ prolapse)
• Uterine support tissue stretching
• Elasticity loss

The following tests may be conducted:

• Blood test
• Pelvic examination
• Vaginal acidity test
• Urine test
• Vaginal smear test

The vaginal smear test is the examination of tissues through a microscope taken from the walls of the vagina. It identifies some form of bacteria and cells that are common with vaginal atrophy.

A paper indicator strip is put in your vagina to test acidity.  Samples of urine and blood may also be requested for laboratory analysis and testing. These tests look for a number of factors, including levels of estrogen.

Treatment

Through treatment, the health of your vagina can improve together with the quality of your life. Treatment can be based on the underlying cause or the symptoms that are present.

To treat dryness, you can use water-based lubricants or over-the-counter moisturizers. Estrogen restores the elasticity of your vagina and the natural moisture. It takes only a few weeks for it to be effective. You can take estrogen orally or topically.

 

Topical estrogen

When estrogen is taken via the skin, the quantity of estrogen that goes into your bloodstream is limited. These forms of estrogen treatments are not linked with endometrial cancer. You should, however, contact your doctor immediately if you have vaginal bleeding that is unusual when using topical estrogen.

Topical estrogen can be found in the following forms:

• A vaginal estrogen ring like Estring. This is a ring that soft and flexible that is placed in your vagina’s upper area. It constantly releases an estrogen dose and is replaced every 3 months. Estrogen rings contain higher estrogen doses, so they make women more prone to endometrial cancer. Consult with your doctor before using one.
• A vaginal estrogen cream like Estrace or Premarin. These are put in the vagina using an applicator when going to bed.
• A vaginal estrogen tablet like Vagifem. This is put in the vagina with an applicator that is disposable. When starting, one dose is recommended and then 1 or 2 times every week after that.

 

Oral estrogen

Oral estrogen is mostly used in the treatment of vaginal dryness and hot flashes during menopause. However, using it for long periods increases your risk for certain cancers. Oral estrogen is not prescribed to individuals who have had cancer.

If you have never had cancer, your doctor may prescribe progesterone on top of estrogen in the form of a patch or a pill.

When using estrogen and progesterone, you may have some bleeding after menopause. Although there is a low risk for cancer when using both estrogen and progesterone, you should see your physician in case you have postmenopausal bleeding.

 

Lifestyle and prevention

Apart from medication, you should also make some lifestyle changes.

You can relieve your symptoms by putting on cotton underwear and clothes that are loose-fitting. Cotton clothes that are loose enhance the circulation of air in the genitals, discouraging bacteria to develop.

If you have vaginal atrophy, you may have pain during intercourse. You should, however, remain sexually active, since it improves the circulation of blood in your vagina and encourages natural moisture. The levels of estrogen are not affected by sexual activity. To make sexual intercourse more comfortable, you should allow time to get aroused sexually.

You can also use vitamin E oil as a lubricant. Vitamin D is also known to increase your vaginal moisture, as well as assist your body in the absorption of calcium. This assists in prevention or slowing of menopausal bone loss, particularly if you do regular exercise.

 

Presentation

Since the majority of women are embarrassed about talking about their vaginal problems, it is crucial to start discussion about vaginal dryness with women who are postmenopausal. Women should understand that vaginal atrophy is a chronic condition that can greatly affect one’s sexual health and life quality. However, they should also understand that there are safe and effective treatments for the condition.