Vaginal atrophy is a common symptom of menopause and can also occur postmenopause. It’s also called genitourinary syndrome of menopause (GSM) and has previously been called vulvovaginal atrophy.
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Vaginal atrophy is a common symptom of menopause and can also occur postmenopause. It’s also called genitourinary syndrome of menopause (GSM) and has previously been called vulvovaginal atrophy.
Vaginal atrophy is a side effect of hormonal changes that happen during menopause. The shifts can cause the vaginal walls to become dry and thin.
This condition guide provides additional details about vaginal atrophy, including its symptoms, what causes it, and how a healthcare provider diagnoses and treats it.
Vaginal atrophy happens when the walls of the vagina become drier and thinner in response to changing estrogen levels. This can lead to symptoms like vaginal dryness, irritation, and painful sex.
Vaginal atrophy is also called genitourinary syndrome of menopause (GSM). GSM replaces older terms, like atrophic vaginitis and vulvovaginal atrophy.
GSM is common in perimenopausal and postmenopausal women. In fact, researchers estimate that more than 50 percent of women experience GSM during the menopause transition.
Vaginal atrophy can cause a variety of symptoms. If you’re experiencing vaginal atrophy, you may notice symptoms like:
Vaginal dryness
Irritation, itching, or burning of the vulva
Pain during sexual intercourse (dyspareunia) due to reduced vaginal lubrication
The symptoms may pose a further-reaching impact on your sex life. For example, one study correlated GSM-related vaginal dryness and painful sex with decreased sexual satisfaction and sexual avoidance due to lack of desire or fears about pain.
It’s also possible that vaginal atrophy may be accompanied by other GSM symptoms, such as the following urinary symptoms:
Painful or burning urination
Frequent or urgent urination
Urinary incontinence
A higher risk of urinary tract infections (UTIs)
Vaginal atrophy happens due to shifts in hormone levels, specifically estrogen. Estrogen is important for promoting blood flow to the genitals as well as for maintaining the elasticity, lubrication, and pH of the vagina.
During perimenopause, which is the timeframe leading up to menopause, the ovaries produce increasingly less estrogen. This hormonal drop is responsible for many common symptoms of menopause.
Less estrogen can mean that vaginal walls become thinner, drier, and less elastic, and the vagina’s pH may increase. This can lead to the following issues:
Thinning and drying of vaginal tissue may mean irritation and burning sensations, especially during sexual activity.
Less vaginal discharge can cause vulvar irritation.
A loss of elasticity can cause the vaginal canal to shorten and narrow, further contributing to discomfort during sex.
Increases in vaginal pH can cause a loss of the microbes typically found in the genital area, boosting the risk of vaginal infections and UTIs.
The changes associated with the menopause transition aren’t the only potential causes of GSM. The condition can also develop due to other factors associated with lower estrogen levels, such as:
Primary ovarian insufficiency, which describes ovaries that, prior to age 40, stop functioning normally
Surgical removal of both ovaries
Breastfeeding
Side effects of cancer treatments like chemotherapy and radiation therapy
Antiestrogen medications that treat medical conditions like fibroids, endometriosis, and breast cancer
Hypothalamic amenorrhea, a condition where your brain stops sending signals to your ovaries, causing your period to stop
Certain characteristics can boost the risk of experiencing vaginal atrophy and other GSM symptoms. These are referred to as risk factors.
The presence of risk factors doesn’t guarantee you will develop vaginal atrophy. It simply means that you’re at a higher risk of getting it than people without risk factors.
Menopause is one of the main risk factors for vaginal atrophy. Perimenopause typically starts between the ages of 45 and 55 and can continue for several years before you reach menopause. The average age of menopause is 52.
Research suggests that advancing menopause stage is linked to a higher risk of vaginal dryness. That means that the further you are on your menopause transition, the more likely you are to experience vaginal atrophy symptoms.
Aside from natural menopause, other factors that increase the risk of vaginal atrophy can include:
Primary ovarian insufficiency
The removal of both ovaries
Other medical conditions — such as hypothalamic amenorrhea — that can affect estrogen levels or the function of your ovaries
Treatment with chemotherapy, radiation therapy, or antiestrogen medications
Lifestyle factors, like excess alcohol consumption and smoking
If you’re concerned that you may be experiencing vaginal atrophy, make an appointment with an OB-GYN or another healthcare provider to discuss it.
A physical exam and additional testing are typically not necessary prerequisite steps for receiving treatments like hormone replacement therapy (HRT) for symptoms of menopause. However, a healthcare provider can use various tests and tools to help diagnose vaginal atrophy.
To diagnose vaginal atrophy, a healthcare provider will start by getting your medical history. Expect questions about the following information:
Your current symptoms, how long you’ve been having them, and their severity
Other medical conditions
Medications you take
Your lifestyle habits
Next, your healthcare provider may perform a physical assessment, including a pelvic exam and potentially testing of your vaginal pH.
Your healthcare provider may also use tools to assess your vaginal health. These include the vaginal maturation index (VMI) and the vaginal health index (VHI).
The VMI evaluates your level of vaginal aging based on analysis of a cell sample. Meanwhile, the VHI assesses your level of vaginal atrophy based on five factors, with lower scores indicating more atrophy. The five factors are:
Elasticity
Secretions
pH
Hydration
Mucous membrane health
A medical history and physical exam generally provide sufficient data to diagnose vaginal atrophy.
However, your healthcare provider may order other tests — such as urinalysis, biopsy in the case of concern of a dermatologic issue, and sexually transmitted infection (STI) testing — to help rule out an infection as the cause of your symptoms.
If you’ve been wondering, “Can vaginal atrophy be reversed?” the answer is generally no. That’s because the condition most often develops as a result of the natural aging process.
However, that doesn’t mean that you have to deal with vaginal discomfort or pain forever. Seeking treatment for vaginal atrophy symptoms is a great way to reduce the impact of the issue.
Visiting a healthcare provider is a great first step to get started with effective treatment options, such as hormone therapy, which can aid in alleviating your symptoms.
Vaginal atrophy treatment may include some form of hormone therapy. Hormone therapy, also called hormone replacement therapy (HRT), replaces missing (or depleted) hormones like estrogen and progesterone.
There are two types of hormone therapy:
Systemic hormone therapy. This type of hormone therapy acts throughout your body and can also help to relieve other common symptoms of menopause, like hot flashes and night sweats. It comes as a pill, skin patch, or gel.
Local hormone therapy. If your symptoms are limited to vaginal atrophy, local estrogen therapy may be recommended. Vaginal estrogen therapy contains low-dose estrogen and comes in the form of estrogen creams, rings, or suppositories.
If you’re not interested in hormonal treatments, you might consider ospemifene (Osphena®), which is an oral medication that’s approved by the Food and Drug Administration to treat moderate-to-severe vaginal dryness and pain during sex. It works by binding to and stimulating estrogen receptors in vaginal tissue.
Both systemic (not local) estrogen-only hormone therapy and ospemifene may increase the risk of serious blood clots and endometrial cancer. Make sure to weigh the risks and benefits with your healthcare provider before getting started.
In addition to prescription medications for vaginal atrophy, there are also a variety of over-the-counter treatments you can explore to reduce vaginal dryness and pain during sex. Two examples include vaginal moisturizers and lubricants.
Vaginal moisturizers — applied to the vagina regularly, around one to three times per week — help hydrate the walls of the vagina, which can promote lubrication and reduce symptoms like irritation and itching. Vaginal moisturizers may also improve the integrity and elasticity of vaginal tissue.
Vaginal moisturizers can come in several forms, including creams or gels that you apply to your vagina using an applicator. They are also available as suppositories that you insert into your vagina.
Lubricants — applied during sex to reduce friction — can lower pain during sex. Lubricants are available as water-based, silicone-based, or oil-based. Water-based lubricants tend to have fewer side effects, like less genital irritation.
Vaginal atrophy can also occur with other symptoms of GSM, such as urinary urgency, urinary incontinence, and UTIs. There are treatments available for these as well.
For example, bladder training may be useful for urinary urgency or incontinence. This involves working with a healthcare provider to learn techniques to help you increase the length of time between urinations.
Pelvic floor therapy may also help: These are essentially exercises that strengthen the muscles you use to control the release of urine.
Typically, you treat a UTI with a course of antibiotics. If you’re having frequent UTIs, the American Urological Association recommends local hormone therapy with estrogen to help reduce UTI risk.
Because vaginal atrophy is often due to natural menopause, there’s not a surefire way to prevent it. However, you can take action to reduce its impact on your sexual health and quality of life.
Certain lifestyle changes may also be beneficial:
Engaging in regular sexual stimulation to boost vaginal blood flow and secretions
Reducing alcohol consumption
Quitting smoking
If you have increased urinary urgency or incontinence, lifestyle changes may help with this as well:
Managing the amount of fluids you drink each day
Reducing your intake of caffeine and alcohol, which can increase your urge to urinate
Quitting smoking
Maintaining a healthy weight
If you’re having bothersome symptoms, like vaginal dryness and pain during sex, vaginal atrophy may be the cause. This common condition is a result of low estrogen and leads the vaginal walls to become thin and dry.
Effective treatment options are available for vaginal atrophy. That means you don’t have to live with uncomfortable symptoms. Seeing your healthcare provider is the first step in getting relief. Managing symptoms of vaginal atrophy can help protect your quality of life.
Technically yes. Atrophic vaginitis is an older term that was previously used for vaginal atrophy, which is also called genitourinary symptoms of menopause (GSM).
If you’re experiencing symptoms of vaginal atrophy, you’re certainly not alone. More than half of women in perimenopause have symptoms of GSM, or vaginal atrophy.
If you have vaginal atrophy, you may notice vaginal dryness, which can make sex painful. Irritation of the vulva, which can also include itching or burning sensations, may also occur.
You likely can’t completely reverse vaginal atrophy, since it’s associated with natural aging. However, a variety of treatments can help to improve vaginal lubrication and reduce irritation.
If sex is painful and you’ve also noticed a decrease in vaginal lubrication and an increase in vaginal irritation or itching, make an appointment with your healthcare provider.
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