Vaginal atrophy, also known as genitourinary syndrome of menopause (GSM), is a common condition where the vaginal walls become thin, dry, and inflamed due to reduced estrogen levels. This often occurs after menopause, but it can also affect individuals at other life stages. While the underlying cause of decreased estrogen may not be fully “reversed,” the symptoms of vaginal atrophy are largely treatable and can be significantly improved with appropriate interventions.
Understanding Vaginal Atrophy
Vaginal atrophy primarily results from a decrease in estrogen production, a hormone essential for maintaining the health and elasticity of vaginal tissues. This decline in estrogen is most commonly associated with menopause, but it can also occur during perimenopause, breastfeeding, or after medical treatments such as surgical removal of the ovaries, chemotherapy, or pelvic radiation therapy. When estrogen levels drop, vaginal tissues become thinner, drier, less elastic, and more fragile. This also affects natural lubrication and the vagina’s acidic balance, making it more susceptible to irritation and infection.
Common symptoms include vaginal dryness, burning, itching, and discomfort or pain during sexual activity (dyspareunia). GSM can also lead to urinary symptoms, as bladder and urethra tissues are estrogen-dependent. These may include urgency, frequent urination, burning, and an increased risk of recurrent urinary tract infections (UTIs).
Treatment Approaches
The goal of treatment is to restore the health and function of vaginal tissues. Local hormonal therapies are often highly effective. These include vaginal estrogen in forms such as creams, tablets, or rings, which deliver low doses of estrogen directly to the vaginal tissues. This localized delivery thickens the vaginal lining, increases natural lubrication, and restores the vagina’s normal pH balance, with minimal systemic absorption. Studies indicate that local estrogen therapy can alleviate symptoms in 80-90% of cases and may also reduce the risk of recurrent UTIs.
Systemic hormone therapy, involving estrogen pills, patches, or gels, may be considered if there are other widespread menopausal symptoms like hot flashes in addition to vaginal atrophy. This approach delivers higher doses of estrogen throughout the body, benefiting vaginal health and other menopausal symptoms.
For individuals who prefer non-hormonal options or for whom hormonal therapy is not suitable, several alternatives exist. Vaginal moisturizers, applied every few days, restore moisture to the vaginal area and have longer-lasting effects than lubricants, which are used just before sexual activity to reduce friction and pain.
Other non-hormonal treatments include Ospemifene, an oral medication that acts as a selective estrogen receptor modulator (SERM). Ospemifene works by selectively binding to estrogen receptors in vaginal tissue, promoting the health of the vaginal lining and improving lubrication, elasticity, and thickness, without significant estrogenic effects on the breast or endometrium. Another option is vaginal DHEA (prasterone) suppositories, inserted nightly, which convert into estrogen and androgens directly in the vaginal tissues, helping to ease painful sex and improve tissue health. Vaginal dilators can also be used to gently stretch and stimulate vaginal muscles, helping to reverse narrowing and improve comfort, especially during sexual activity.
Maintaining Vaginal Health
Maintaining improvements achieved through treatment requires ongoing attention to vaginal health and adopting certain lifestyle practices. Regular sexual activity, whether with a partner or through self-stimulation, promotes blood flow to the vaginal area, helping maintain tissue elasticity and natural lubrication. Consistent physical activity also increases overall blood circulation, benefiting vaginal tissues.
Avoiding irritants is another strategy for long-term comfort. This includes steering clear of harsh soaps, douches, and scented products, which can disrupt the natural pH balance of the vagina and lead to irritation. Opting for breathable cotton underwear and loose-fitting clothing can also help prevent irritation by promoting air circulation and reducing moisture buildup. Staying well-hydrated by drinking adequate amounts of water is important for overall bodily hydration, including the vaginal area, contributing to tissue moisture and elasticity. These ongoing measures reinforce the benefits of medical treatments, contributing to sustained comfort and improved vaginal health over time.