Atrophic Vaginitis (Vaginal Dryness)

What is atrophic vaginitis and what causes it?

The skin and tissues around the vagina are kept supple and moist by fluids and mucus that are made by glands at the neck of the womb. Oestrogen (the female hormone) affects these glands. 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 protein which encourages the presence of 'helpful' bacteria which help to protect the vagina from infection.

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

As a result, the vagina can become shorter, less elastic, and dryer with less lubricating mucus. The genital skin looks paler. These changes usually take months or years to develop following the menopause, and vary between women. Atrophic vaginitis is the medical term for the condition when these changes produce troublesome symptoms.

How common is atrophic vaginitis?

After the menopause about 1 in 2 women have some symptoms related to atrophic vaginitis. The frequency of symptoms increases with increasing age past the menopause.

What symptoms can occur?

The changes described above may occur, but 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 easily made sore, and this can make the problem worse.
• Discomfort - if the vulva or vagina is sore and inflamed.
• Vaginal discharge. A white or yellow discharge may occur. Sometimes this is due to an infection because the vagina is less resistant to infection after the menopause. Infection is more likely if the vaginal 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 scratch, 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 be a contributing factor to various urinary problems. This is due to 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.

What are the treatments for atrophic vaginitis?

Not all women have all of the above symptoms. Treatment may depend on which symptoms are the most troublesome. Because 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. See separate leaflet called 'The Menopause and HRT' for more detail.

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 after a period of time on 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. There are various gels which are specifically designed to help the problem of vaginal dryness by replacing moisture (for example, Replens®). You can buy these from the pharmacy and your pharmacist can advise.