atrophic vaginitis

After menopause some women may notice changes in their vagina and genital area, which may include dryness and discomfort during sex. There may also be bladder symptoms. All these can all usually be improved with treatment. Treatment options include hormone replacement therapy (HRT), oestrogen cream or pessaries and lubricating gels.

What do you understand by atrophic vaginitis and what causes it?

Oestrogen hormone is the female hormone, which helps maintain the function of glands around the neck of the womb, which further in turn secrete fluids and mucus to maintain the  tissue and skin around the vagina, supple and moist . Oestrogen also affects the tissues in and around the vagina, causing the lining of the vagina to be thicker and more elastic.

Oestrogen also stimulates the cells that line the vagina to produce glycogen, a compound which encourages the presence of helpful bacteria which protect the vagina from infection.

After the menopause the ovaries make less oestrogen. The lack of oestrogen leads to thinning of the tissues around the vagina and a reduction in the number of glands that make mucus. You also lose some fat tissue from around the genital area. This may make the area also look slightly different than before the menopause.

In summary, the hormonal changes make the vagina shorter, less elastic and drier. The genital skin also looks paler. These changes usually take months or years to develop after the menopause and vary from woman to woman. Atrophic vaginitis is the medical term for the condition when these changes produce troublesome symptoms.

How do they present?

The changes of menopause can occur without causing any symptoms or discomfort. However, some of the following symptoms may develop in some women. Atrophic vaginitis is a common (and usually treatable) cause of the following problems. However, these problems can also be caused by other medical conditions.

  • Pain when you have sex. This may occur because the vagina is smaller, drier and less likely to become lubricated during sex than before the menopause. Also, the skin around the vagina is more fragile, and this can make the problem worse.
  • Discomfort - if the vulva or vagina is sore and red.
  • Vaginal discharge. There may be a white or yellow discharge. Sometimes this is due to an infection. Infection is more likely if the discharge is smelly and unpleasant.
  • Itch. The skin around the vagina is more sensitive and more likely to itch. This can make you prone to scratching, which then makes the skin more likely to itch, and so on. This is called an itch/scratch cycle which can become difficult to break, and can be distressing.
  • Urinary problems. Atrophic vaginitis may contribute to various urinary problems. This is because of thinning and weakening of the tissues around the neck of the bladder, or around the urethra (opening for urine). For example, urinary symptoms that may occur include an urgency to get to the toilet, and recurring urinary infections.

How do you treat atrophic vaginitis?

The  treatment depends on the symptoms which are most troublesome. As the problem is mainly due to a lack of oestrogen, it can be helped by replacing the oestrogen in the tissues.

Hormone replacement therapy (HRT)

This means taking oestrogen in the form of a tablet, gel, implant or patches. This may be the best treatment for relieving the symptoms, but some women don't like the idea of taking HRT. There are advantages and disadvantages of using HRT.

Oestrogen creams

Sometimes a cream, pessary or vaginal ring containing oestrogen is prescribed. This restores oestrogen to the vagina and surrounding tissues without giving oestrogen to the whole body. Usually the treatment is used every day for about two weeks, and then twice a week for a further three months. After this the effect of the treatment may be assessed by your doctor. This treatment usually works well but the symptoms may recur some time after stopping the treatment. Repeated courses of treatment are often necessary. It is important to follow the instructions about the amount of cream to use.

Lubricating gels

If vaginal dryness is the only problem, or hormone creams are not recommended because of other medical problems, lubricating gels may help. They replace moisture.

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