- Things to Know
- Symptoms & Signs
Things to know about vaginal dryness and vaginal atrophy
- Vaginal atrophy is the medical term that refers to the thinning of the wall of the vagina that occurs during menopause (the time after menstrual periods have ceased) in women.
- Vaginal atrophy occurs due to falling estrogen levels.
- Vaginal atrophy may be associated with vaginal dryness, itching, irritation, and/or pain during sexual intercourse.
- Hormone therapy can be effective in treating vaginal atrophy and other menopausal symptoms, but hormone therapy carries its own risks.
- Local vaginal hormone creams or vaginal lubricants are alternatives to systemic hormone therapy.
What causes vaginal dryness and vaginal atrophy?
Vaginal atrophy is the medical term that refers to the thinning of the wall of the vagina that occurs during menopause (the time when menstrual periods have ceased) in women. Prior to menopause, the vaginal lining appears plump, bright red, and moist. As estrogen levels decline, the lining of the vagina becomes thinner, drier, light pink to bluish in color, and less elastic. This is a normal change that is noticed by many perimenopausal and postmenopausal women.
Estrogen levels begin to fall as menopause approaches. Estrogens are mainly produced by the ovaries. Estrogens control the development of female body characteristics such as breasts, body shape, and body hair. Estrogens also play a significant role in the regulation of the menstrual cycle and pregnancy.
Most women reach menopause between the ages of 45-55, but it can occur earlier or later in life. The menopause average age is 51 years old. Every woman is different, and there is no definitive way to predict when an individual woman will enter menopause. Also, women in the menopausal transition experience symptoms with varying degrees of severity. Not all perimenopausal and postmenopausal women will have the same symptoms or experience the same levels of severity.
What symptoms can be associated with vaginal dryness and vaginal atrophy?
Other vaginal symptoms that are commonly associated with vaginal atrophy include vaginal dryness, itching, irritation, and/or pain with sexual intercourse (known as dyspareunia). The vaginal changes also lead to an increased risk of vaginal infections.
In addition to the vaginal symptoms, women may experience other symptoms of the menopausal transition. Hot flashes, night sweats, mood changes, fatigue, urinary tract infections, urinary incontinence, acne, memory problems, and unwanted hair growth.
How do medical professionals diagnose vaginal dryness and vaginal atrophy?
Vaginal symptoms such as itching, dryness, or pain with sexual intercourse are typically sufficient to assume that a woman is suffering from vaginal dryness and vaginal atrophy if she is experiencing other symptoms consistent with the menopausal transition. Of course, a careful physical examination, including a pelvic examination, is necessary to rule out other conditions (such as infections) that may be causing vaginal symptoms.
There are no specific tests available to determine whether the vaginal wall has become thinner or less elastic.
What treatments are available for vaginal dryness and vaginal atrophy?
Vaginal dryness and atrophy do not need to be treated unless they cause symptoms or discomfort. Women who experience symptoms have several treatment options.
Hormone therapy (HT) is effective in treating vaginal dryness/vaginal atrophy. HT has also been referred to as hormone replacement therapy (HRT) or postmenopausal hormone therapy (PHT). HT has been shown to effectively reduce vaginal dryness as well as help control hot flashes associated with menopause.
However, HT is not without its risks. Long-term studies (the NIH-sponsored Women's Health Initiative, or WHI) of women who took oral combined hormone therapy containing both estrogen and progesterone showed that these women had an increased risk for heart attack, stroke, and breast cancer when compared with women who did not receive it.
Women taking oral estrogen alone had an increased risk for stroke, but not for heart attack or breast cancer. Estrogen therapy alone, however, is associated with an increased risk of developing endometrial cancer (cancer of the lining of the uterus) in postmenopausal women who have not had their uterus surgically removed.
HT may be administered in pill form or transdermally (patches or sprays from which the medication is absorbed through the skin). Transdermal estrogens enter the circulation directly, where oral estrogen products must first pass through the liver from the stomach. Since transdermal hormone products do not have effects on the liver, this route of administration has become the preferred form for most women. A number of preparations are available for oral and transdermal forms of HT, varying in the both type and amount of hormones in the products.
So-called "bioidentical" hormone therapy for perimenopausal women has been a source of much attention in recent years. Bioidentical hormone preparations are hormones with the same chemical formula as those made naturally in the body but which are produced in a laboratory by altering compounds derived from naturally-occurring plant products. While some of these preparations are U.S. FDA-approved and manufactured by drug companies, others are made at special pharmacies called compounding pharmacies, which make the preparations on a case-by-case basis for each patient. Since individually compounded products cannot be standardized, these individual preparations are not regulated by the FDA. There is no evidence that bioidentical preparations provide superior symptom relief. Studies to establish the long-term safety and effectiveness of these products have not yet been carried out.
No matter what form of therapy is used, the decision about hormone therapy should take into account the inherent risks and benefits of the treatment along with each woman's own medical history and the severity of her symptoms. Current recommendations state that if hormone therapy is used, it should be used at the smallest effective dose for the shortest possible time.
There are also local, topical (meaning applied directly to the vagina) low-dose hormonal treatments for the symptoms of vaginal dryness and vaginal atrophy. Local treatments include the vaginal estrogen ring, vaginal estrogen cream, or vaginal estrogen tablets. Local (vaginal) estrogen treatments can be very effective in reducing vaginal dryness while having a minimal effect on other tissues in the body.
There is also now a product for vaginal dryness that consists of a daily pill which contains a selective estrogen receptor modulator (SERM). These are theoretically safer than estrogens and can be alternative for some patients.
Vaginal moisturizing agents such as creams or lotions (for example, K-Y Silk-E Vaginal Moisturizer or KY Liquibeads Vaginal Moisturizer) as well as the use of lubricants during sexual intercourse are non-hormonal options for managing the discomfort of vaginal dryness. A longer acting moisturizer called Replens is also available over the counter.
Applying Betadine topically on the outer vaginal area, and soaking in a sitz bath or soaking in a bathtub of warm water may be helpful for relieving symptoms of burning and vaginal pain after intercourse.
What is the prognosis for vaginal dryness and vaginal atrophy?
Vaginal dryness and vaginal atrophy are common complaints in postmenopausal women. While these conditions do not produce serious consequences, they are a source of significant discomfort for many women. Hormone treatments are available that are very effective in reducing vaginal dryness, but whether or not to use hormone therapy is an individual decision that must consider the inherent risks and benefits of the treatment along with each woman's own medical history. Women with only mild symptoms may experience relief by using vaginal moisturizing agents and/or lubricants during sexual intercourse.
Rossouw, J.E.; Anderson, G.L.; Prentice, R.L., et al. "Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial." JAMA . 2002 Jul 17;288(3):321-33. doi: 10.1001/jama.288.3.321.
Utian, W.H.; Archer, D.F.; Bachmann, G.A., et al. "Estrogen and progestogen use in postmenopausal women: July 2008 position statement of The North American Menopause Society." Menopause. 2008 Jul-Aug;15(4 Pt 1):584-602.
Top Vaginal Dryness and Vaginal Atrophy Related Articles
9 Signs of PerimenopausePerimenopause occurs before menopause as estrogen levels begin to change. This can cause menopause like symptoms such as hot flashes, night sweats, heavy bleeding, weight gain, vaginal dryness, and changes to libido. Pregnancy is still possibly during perimenopause.
Bacterial Vaginosis (BV)Bacterial vaginosis is an abnormal vaginal condition with signs and symptoms of vaginal discharge, vaginal odor, and vaginal pain. It results from an overgrowth of normal bacteria in the vagina.
25 Hormone Imbalance Symptoms and SignsHormone imbalance involves changes in estrogen, progesterone, and other hormone levels. Hormonal imbalance in women may cause symptoms like weight gain, hot flashes, fatigue, and acne. Hormonal changes happen in menopause and at other times. Women with hormone imbalances can seek treatment from medications like triptans and SSRIs.
Hormone TherapyEstrogen therapy, estrogen/progestin therapy, and hormone therapy are terms that refer to the administration of estrogen or estrogen/progestin for the purpose of suppressing hot flashes. Side effects of hormone therapy include headaches, nausea, breast pain, blood clots, breast cancer, heart disease, abnormal vaginal bleeding, stroke, and uterine cancer.
How Long Does it Take for a Vaginal Suppository to Absorb?Vaginal suppositories take between 15 and 30 minutes to dissolve and get absorbed into the body. The absorption of a vaginal suppository depends on several factors, including the type of suppository, active ingredient, pH and moisture level of the vaginal environment, and the size and shape of the suppository. The time for the absorption process of a vaginal suppository to complete can vary widely and is difficult to determine.
How Many Days Before a Period Do You Get Discharge?Vaginal discharge is a normal part of a woman's menstrual cycle. Learn about vaginal discharge before a period, how many days you get discharge before your period, signs and causes of vaginal discharge, and when to see a doctor if there's a problem. Vaginal discharge is the fluid secreted from the uterus, cervix (neck of the uterus) and vagina. A thick yellow vaginal discharge may point to vaginitis (infection of the vagina).
Is It Normal to Have Discharge After Sex?What is vaginal discharge? Learn the signs of vaginal discharge and what to do if you experience it.
Kidney Infection (Pyelonephritis)Kidney infection (pyelonephritis) usually is caused by E. coli and other bacteria that have spread from the bladder from a UTI (urinary tract infection), poor hygiene, sexual intercourse, pregnancy, catheter, cystoscope exam, surgery, kidney stones, or prostate enlargement. Symptoms of kidney infection include back pain, frequent urination, pain during urination, fever, and or pus or blood in the urine. Kidney infection can be cured with antibiotic treatment. Cranberry juice may prevent UTIs, but that hasn’t been proven in all research studies.
MenopauseMenopause is the time in a woman's life when menstrual periods permanently stop, also called the "change of life." Menopause symptoms and signs include hot flashes, night sweats, irregular vaginal bleeding, vaginal dryness, painful intercourse, urinary incontinence, weight gain, and emotional symptoms such as mood swings. Treatment of menopausal symptoms varies and should be discussed with your physician.
Night sweats are severe hot flashes that occur at night and result in a drenching sweat. The causes of night sweats in most people are not serious, like menopause in women, sleep apnea, medications, alcohol withdrawal, and thyroid problems. However, more serious diseases like cancer and HIV also can cause night sweats. Your doctor will treat your night sweats depending upon the cause.
You may experience other signs and symptoms that are associated with night sweats, which depend upon the cause, but may include, shaking, and chills with a fever caused by an infection like the flu or pneumonia; unexplained weight loss due to lymphoma; women in perimenopause or menopause may also have vaginal dryness, mood swings, and hot flashes during the day; and low blood sugar in people with diabetes.
Other causes of night sweats include medications like NSAIDs (aspirin, acetaminophen, ibuprofen (Motrin, Advil), and naproxen (Aleve, Naprosyn), antidepressants, sildenafil (Viagra), and abuse of prescription or illegal drugs and drug withdrawal; hormone disorders like pheochromocytoma and carcinoid syndrome; idiopathic hyperhidrosis; infections like endocarditis, AIDs, and abscesses; alcoholism and alcohol withdrawal; drug abuse, addiction, and withdrawal; and stroke.
A doctor or other health care professional can treat your night sweats after the cause has been diagnosed.
PerimenopausePerimenopause is the time in a woman's life when she is approaching menopause. During this time a woman starts to develop symptoms of declining estrogen levels that may include mood swings, painful sex, night sweats, hot flashes, and weight gain. Every adult woman eventually will experience perimenopause.
Vagina PictureThe vagina is an elastic, muscular canal with a soft, flexible lining that provides lubrication and sensation. See a picture of the Vagina and learn more about the health topic.
Vaginal Yeast Infection
Vaginal yeast infections in women are caused by an organism called Candida albicans. Symptoms of a vaginal yeast infection include vaginal pain with urination, vaginal discharge, odor, and itching.
Treatment is generally OTC medications. A man can contract a yeast infection from his female sexual partner. Symptoms of a yeast infection in men include penile itching. Treatment is with oral or topical medication.