Vaginal Atrophy

Description

Vaginal atrophy (atrophic vaginitis) is thinning, drying and inflammation of the vaginal walls that may occur when your body has less estrogen. Vaginal atrophy occurs most often after menopause.

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.

Simple, effective treatments for genitourinary syndrome of menopause (GSM) are available. Reduced estrogen levels result in changes in your body, but this does not mean that you have to live with the discomfort of GSM .

Symptoms

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

  • Vaginal dryness
  • Vaginal Burning
  • Vaginal Discharge
  • Genital itching
  • Burning with urination
  • The urgency with urination
  • Frequent need to urinate
  • Recurrent urinary tract infections
  • Urinary incontinence
  • Light bleeding after sex
  • Discomfort during sexual intercourse
  • The decreased vaginal lubrication during sexual activity
  • Shortening and tightening of the vagina

When to see a doctor

Many postmenopausal women experience GSM . But few seek treatment. Women may be embarrassed to discuss your symptoms with your doctor and you may be resigned to live with these symptoms.

Make an appointment with your doctor if you have any unexplained vaginal spotting or bleeding, unusual discharge, burning or pain.

Also make an appointment to see your doctor if you experience pain at the sexual intercourse that is not solved by using a vaginal moisturizer (K-y Liquibeads, Replens, Sliquid, others) or water-based lubricant (Astroglide, K-y Jelly, Sliquid, others).

Causes

Genitourinary syndrome of menopause is caused by a decrease in estrogen production. Less estrogen causes your vaginal tissues thinner, drier, less elastic and more fragile.

A drop in estrogen levels may occur:

  • After the menopause
  • During the years leading up to menopause (perimenopause)
  • After the surgical removal of both ovaries (surgical menopause)
  • During the period of lactation
  • While you are taking medicines that can affect levels of estrogen, such as some birth control pills
  • After pelvic radiotherapy for cancer
  • After chemotherapy for cancer
  • As a side effect of breast cancer hormone treatment

GSM signs and symptoms may start to bother you during the years leading up to menopause, or may not become a problem until several years in the menopause. Although the condition is common, not all menopausal women experience GSM . Regular sexual activity, with or without a partner, can help to maintain healthy vaginal tissues.

Risk factors

There are certain factors that can contribute to GSM , such as:

  • The habit of smoking. Smoking affects the blood circulation, and can slow the flow of blood and oxygen to the vagina and other nearby areas. Smoking also reduces the effects of natural estrogen in your body.
  • No vaginal births. Researchers have observed that women who have never given birth vaginally are more likely to develop GSM symptoms that women who have had vaginal births.
  • Without sexual activity. Sexual activity, with or without a partner, increases blood flow and makes your vaginal tissues more elastic.

Complications

Genitourinary syndrome of menopause increases the risk of:

  • Vaginal infections. Changes in the acid balance of the vagina and make yeast infections more likely.
  • Urinary problems. Urinary changes associated with GSM can contribute to urinary problems. You may experience an increased frequency or urgency of urination or burning when you urinate. Some women have more urinary tract infections or leakage of urine (incontinence).

Prevention

Regular sexual activity, either with or without a partner, can help prevent genitourinary syndrome of menopause. Sexual activity increases blood flow to the vagina, which helps to keep vaginal tissues healthy.

Vaginal Atrophy

Diagnosis

The diagnosis of genitourinary syndrome of menopause (GSM) may involve:

  • Pelvic exam, during which your doctor feels that your pelvic organs and visually examines your external genitalia, vagina and cervix.
  • Urine test, which involves the collection and analysis of urine, if you have urinary symptoms.
  • Acid balance of the test, which involves taking a sample of vaginal fluid, or the placement of an indicator paper strip in your vagina to test your acid balance.

Treatment

For treating 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 a little bit of moisture to your vaginal area. You may have to apply moisturizer every day. The effects of a moisturizer that usually lasts a little longer than those of a lubricant.
  • Water-based lubricants. These lubricants (Astroglide, K-y Jelly, Sliquid, others) is applied just before the sexual activity and can reduce discomfort during intercourse. Choose products that do not contain glycerin or heating of the properties because the women who are sensitive to these substances may experience irritation. Avoid petroleum jelly or other petroleum-based products for the lubrication if you are also using condoms, because the oil can break down latex condoms in contact.

If the options do not relieve your symptoms, your doctor may recommend:

Topical estrogen

Vaginal estrogen has the advantage of being effective at the lower dose and to limit their exposure to estrogen, as less reaches your bloodstream. It may also provide better direct the relief of the symptoms of oral estrogen does.

Vaginal estrogen therapy comes in a number of ways. Because they all seem to work just as well, you and your doctor can decide what is best for you.

  • Vaginal estrogen cream (Estrace, Premarin). Insert this cream directly into the vagina with an applicator, usually at bedtime. Women tend to use daily for one to three weeks, and then one to three times a week from then, but your doctor will let you know how much cream to use and how often to insert it.
  • Vaginal estrogen suppositories (Imvexxy). These low doses of estrogen suppositories are inserted about 2 inches into the vaginal canal daily for weeks. Then, suppositories only need to be inserted twice a week.
  • Vaginal estrogen ring (Estring, Femring). You or your doctor inserts a soft, flexible ring in the upper part of the vagina. The ring releases a constant dose of estrogen, while in their place, and should be replaced every three months. Many women like the convenience that this offers. In a different way, with a greater dose of the ring is considered to be a systemic rather than topical treatment.
  • Vaginal estrogen tablet (Vagifem). Use a disposable applicator to place a tablet vaginal estrogen in your vagina. Your doctor will tell you how often to insert the tablet. You could, for example, that used in daily for the first two weeks and then twice a week thereafter.

Ospemifene (Osphena)

Taken daily, this pill can help to relieve the pain during sex symptoms in women with moderate-to-severe genitourinary syndrome of menopause (GSM). Is not authorised in women who have had breast cancer or who have a high risk of developing breast cancer.

Prasterone (Intrarosa)

These pessaries deliver the hormone DHEA directly to the vagina to help relieve pain during sex. DHEA is a hormone that helps the body produce other hormones, such as estrogen. Prasterone is used night of 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 that estrogen pills, patches or gel, or a higher dose of estrogen ring. Estrogen is taken in through the mouth enters the system in its entirety. Ask your doctor to explain the risks versus the benefits of oral estrogen, and whether or not you will also need to take another hormone called progestin along with estrogen.

Vaginal dilators

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

If painful sex is a concern, vaginal dilators can relieve vaginal discomfort by stretching of the vagina. Are available without a prescription, but if the 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 may be used to reduce the discomfort associated with sexual activity. Apply five to 10 minutes before to start sexual activity.

If you have had breast cancer

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

  • The treatments are non-hormonal. Try moisturizers and lubricants as the first option.
  • Vaginal dilators. Vaginal dilators non-hormonal are an option that can stimulate and stretch the vaginal muscles. This helps to reverse the narrowing of the vagina.
  • Vaginal estrogen. In consultation with your cancer specialist (oncologist), your doctor may recommend a low-dose vaginal estrogen if non-hormonal treatments do not help with the symptoms. However, there is some concern that the vaginal estrogen may increase the risk of the cancer coming back, especially if the breast cancer was hormonally sensitive.
  • Systemic estrogen therapy. Systemic estrogen treatment is not generally recommended, especially if the breast cancer was hormonally sensitive.

Self-care

If you are experiencing vaginal dryness or irritation, you can find relief if you:

  • Try a recipe from the moisturizer. Examples include the K-y Liquibeads, Replens, and Sliquid. This can restore some of the moisture from your vaginal area.
  • The use of 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 the menopause, but some approaches are supported by sufficient evidence of the clinical trials. Interest in complementary and alternative medicine is growing, and researchers are working to determine the benefits and risks of various treatment options for genitourinary syndrome of menopause.

Talk with your doctor before taking any herbal or dietary supplements for perimenopause or menopause symptoms. The Food and Drug Administration does not regulate herbal products, and some may interact with other medicines that you take, putting your health at risk.

Preparing for your appointment

You will probably start by discussing your symptoms with your primary care physician. If you are not seeing a doctor that specializes in women's health (gyn or internal medicine women's health specialist), your primary care provider can refer you to one.

What you can do

To prepare for your appointment:

  • Make a list of the signs and symptoms that you are experiencing. Include those that may seem unrelated to the reason for your appointment.
  • Take note of the key of the personal information. Include any major stresses or recent life changes.
  • Make a list of all the medicines that you take. Includes prescription and nonprescription medicines, vitamins and supplements, and note the dose.
  • Consider the possibility of a family member or friend. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who goes with you may remember something that you missed or forgot.
  • Preparing the questions. Make the most of your time with your doctor for the preparation of a list of questions before your appointment.

Some basic questions to ask include:

  • What is the most likely cause of my symptoms?
  • There are other possible causes?
  • What kinds of tests do I need?
  • Is my condition likely temporary or long-term?
  • What treatment options are available? What do you recommend?
  • What are the alternatives to the primary approach you're suggesting?
  • I have some other health conditions. How can I best manage these conditions?
  • You should see a specialist?
  • Are there brochures or other printed material I can have? What sites do you recommend?

What to expect from your doctor

Your doctor will ask about your symptoms and assess your hormonal status. Questions your doctor may ask include:

  • What is vaginal or urinary symptoms have you noticed?
  • How long have you had these symptoms?
  • Are you still having menstrual periods?
  • How much distress do your symptoms do they cause?
  • Are you sexually active?
  • How your symptoms limit your sexual activity?
  • Has received treatment for cancer?
  • Does the use of scented soaps or bubble bath?
  • How to use douches or feminine hygiene spray?
  • What medications, vitamins, or other supplements you take?
  • Have you tried any over-the-counter moisturizers or lubricants?
Symptoms and treatment of Vaginal atrophy