Vaginal Atrophy Risk Factors, Complications, And Treatment614
The weakening, dryness, and inflammation of the vaginal walls known as vaginal atrophy (atrophic vaginitis) can happen when your body produces less estrogen. Vaginal atrophy most usually happens after menopause.
Many women have painful erections and uncomfortable urinary symptoms as a result of vaginal atrophy. Doctors refer to vaginal atrophy and its accompanying symptoms as "genitourinary syndrome of menopause (GSM)" since the illness affects both vaginal and urine symptoms.
There are easy-to-use, efficient therapies for GSM. Low estrogen levels cause physical changes in your body, but they do not force you to endure the discomfort of GSM.
The menopausal genitourinary condition is brought on by a reduction in estrogen production. Your vaginal tissues become drier, more brittle, less elastic, and thinner as your estrogen levels decline.
There might be a reduction in estrogen levels:
- After menopause
- Before menopause, throughout those years (perimenopause)
- After having both ovaries surgically removed (surgical menopause)
- As a breastfeeding mother
- When using birth control tablets or other drugs that might lower estrogen levels
- After cancer radiation treatment for the pelvis
- After cancer chemotherapy
- An adverse effect of breast cancer hormone treatment
You can start to experience GSM indications and symptoms in the years before menopause, or you might wait until you are far into menopause before they start to affect you. Even though it is a frequent illness, GSM does not affect all menopausal women.
How to check if you have Vaginal Atrophy?
GSM is a common postmenopausal woman's condition. Yet few people seek help. Out of embarrassment, women may choose to accept their symptoms and refrain from discussing them with their doctors.
Make an appointment with your doctor if you experience any unexplained vaginal bleeding, strange discharge, burning, or pain.
Also schedule a visit with your doctor if your painful erections do not subside after using a vaginal moisturizer (K-Y Liquibeads, Replens, Sliquid, or similar products) or water-based lubricant (Astroglide, K-Y Jelly, Sliquid, others).
GSM may be caused by several reasons, such as:
Smoking. Smoking has an impact on blood circulation, which might result in less blood and oxygen reaching the vagina and other adjacent locations. Smoking also lessens the impact of your body's natural oestrogens.
No births via womb. Researchers have shown that women who have never given birth vaginally are more prone than those who have experienced GSM symptoms.
No sex is exchanged. Sexual activity increases blood flow and elongates the tissues in your vagina, both with and without a partner.
The following are indications and symptoms of the Genitourinary Syndrome of Menopause (GSM):
- Virility dryness
- Burns in the cervix
- Virulent discharge
- Urinary itch
- Urinating while burning
- Urge to urinate immediately
- Often urinating
- Urinary tract infections that recur
- A tendency to leak urine
- Light bleeding occurs after sex.
- Uncomfortable during a sex act
- During sexual activity, there is less lubrication in the vaginal canal, which causes it to become shorter and tighter.
Genitourinary syndrome of menopause may be avoided by engaging in regular sexual activity, whether with or without a partner. Your vagina receives more blood when you engage in sexual activity, which supports the health of the tissues there.
Your doctor could first suggest over-the-counter remedies for genitourinary syndrome of menopause, such as:
Moisturizers for the vagina. To replenish some moisture in your vaginal area, try using a vaginal moisturizer (K-Y Liquibeads, Replens, Sliquid, or another brand). The moisturizer might need to be used every few days. In general, a moisturizer's benefits linger a little longer than a lubricant.
Lubricants made of water. When used right before sexual activity, these lubricants (Astroglide, K-Y Jelly, Sliquid, and others) help lessen pain. Glycerin and warming characteristics may irritate women who are sensitive to them, so choose products that do not include any of these ingredients. If you are using condoms as well, stay away from petroleum jelly and other lubricants made of petroleum since they might cause latex condoms to rupture.
Your doctor can suggest:
As less vaginal estrogen enters your circulation, it offers the benefit of being effective at lower levels and reducing your overall exposure to estrogen. Additionally, it could offer more effective immediate symptom alleviation than oral estrogen does.
Various methods of vaginal estrogen treatment exist. You may select which one is ideal for you with the help of your doctor because they all appear to function equally well.
Vaginal cream with estrogen (Estrace, Premarin). Typically at night, you apply this lotion with an applicator straight into your vagina. Typically, women use the cream once to three times per week after using it daily for one to three weeks. However, your doctor will advise you on the appropriate amount.
Estrogen vaginal suppositories (Imvexxy). For many weeks, these low-dose estrogen suppositories are placed daily about 2 inches into the vaginal canal. The suppositories would therefore only need to be placed twice a week.
Estrogen vaginal ring (Estring, Femring). A soft, flexible ring is inserted into the upper vagina by you or your doctor. The ring must be changed roughly every three months and continuously releases estrogen while it is in place. The convenience this gives appeals to many women. A separate ring with a larger dosage is regarded as systemic as opposed to a topical therapy.
Tablet of vaginal estrogen (Vagifem). You insert a vaginal estrogen pill using a disposable applicator. Your physician will inform you about the frequency
to put the pill in. For instance, you may use it twice a week after using it every day for the first two weeks.
Ospemifene (Osphena) is a medication that, when taken regularly, can assist women with moderate to severe GSM to manage their uncomfortable sex sensations. It is not recommended for use in women who have had breast cancer or who are at high risk of getting it.
These vaginal implants, known as prasterone (Intrarosa), administer the hormone DHEA directly to the vagina to lessen the discomfort of arousal. DHEA is a hormone that aids in the production of estrogen and other hormones by the body. For moderate to severe vaginal atrophy, progesterone is administered every night.
Treatment with systemic estrogen
Your doctor may prescribe medication if vaginal dryness coexists with other menopausal symptoms like moderate or severe heat flashes.
Suggest estrogen rings with a larger dosage, patches, gel, or tablets. When consumed orally, estrogen reaches the whole body. Inquire with your doctor about the advantages and disadvantages of taking oral estrogen, as well as whether or not you would also need to take a hormone called progestin at the same time.
Vaginal dilators are a non hormonal therapy alternative that you may employ. In addition to estrogen treatment, vaginal dilation agents may be employed. To stop the vagina from becoming narrower, these devices stimulate and expand the vaginal muscles.
Vaginal dilators can ease vaginal discomfort by expanding the vagina if painful intercourse is an issue. Although they are accessible without a prescription, your doctor could advise pelvic floor physical therapy and vaginal dilators. You can learn how to utilise vaginal dilators from your doctor or a pelvic physical therapist.
Topical lidocaine, which is sold as an ointment or gel by prescription, can be used to ease the pain brought on by sexual activity. Five to ten minutes before starting sexual activity, apply it.
Having had breast cancer
Inform your doctor if you have a history of breast cancer and take the following into consideration:
Therapies without hormones. As a first option, try lubricants and moisturizers.
Vaginal relaxants. A non-hormonal alternative that can energize and expand the vaginal muscles is vaginal dilators. This aids in stopping vaginal narrowing.
Female estrogen. If non-hormonal therapy is unsuccessful, your doctor may suggest low-dose vaginal estrogen in collaboration with your oncologist.
Ailment symptoms. Vaginal estrogen may, however, raise your chance of cancer returning, particularly if your breast cancer was hormonally sensitive.
Treatment with systemic estrogen. In general, systemic estrogen therapy is not advised, particularly if your breast cancer was hormonally sensitive.
Complications of Vaginal Atrophy
Your risk of Vaginal Atrophy is increased by the genitourinary syndrome of menopause if you have the following:
Infections of the vagina. Vaginal infections are more prevalent when your vagina's acid balance changes.
Urinary issues. Urinary issues may be exacerbated by GSM-related alterations in the urinary system. Urination may become more often or urgent, or it may burn more when you urinate. Some women endure more urine leaks or urinary tract infections than others (incontinence).
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Page last reviewed: Mar 21, 2023
Next review due: Mar 21, 2025