Atrophic Vaginitis: Symptoms, Causes, and Treatments


Menopause brings about many life changes that can be both uncomfortable and emotionally difficult to deal with. On top of hot flashes, night sweats, and intense fatigue, you may also notice that you’re spotting after sex and may even be a little bit dry down there. These are all common signs of atrophic vaginitis, and this condition effects many women after menopause.

What is Atrophic Vaginitis?

Postmenopausal atrophic vaginitis is often referred to as vaginal atrophy. This condition occurs when the inner walls of the vagina start thinning, and typically only occurs after menopause.

Usually, menopause occurs between the ages 45-55. During this time, your ovaries will no longer release eggs, and you will stop having menstrual periods. Typically, a woman is considered postmenopausal if she hasn’t had her period in at least 12 months.

Vaginal atrophy increases the chances of developing chronic vaginal infections as well as urinary tract issues. In some cases, it can also make sex painful.

If you’re worried that you have vaginal atrophy, you’re not alone. Up to 40% of postmenopausal women are suffering with atrophic vaginitis, according to the American Association of Family Physicians.

Common Vaginal Atrophy Symptoms

Introduction about vaginal atrophy

While nearly half of postmenopausal women will experience vaginal atrophy, only 20 to 25% actually seek medical attention. Some women don’t experience any symptoms, while others will begin experiencing them during perimenopause.

Common symptoms can include:

  • Spotting after intercourse.
  • Tightening or shortening of the vaginal canal.
  • Thinning of the vaginal walls.
  • Vaginal burning after intercourse.
  • Painful urination.
  • Urinary incontinence.
  • Frequent urinary tract infections.

Some women just assume that the symptoms are just a part of menopause, and feel no need to see their doctor. Others will experience no symptoms at all.

If you’re experiencing painful sexual intercourse, or unusual vaginal burning, bleeding, soreness or discharge, see your doctor immediately.

What Causes Vaginal Atrophy?

What causes the vaginal walls to start thinning, and why does this condition affect mostly postmenopausal women?

The primary cause of atrophic vaginitis is a lack of estrogen. As women approach perimenopause, estrogen levels begin declining naturally, and the progression becomes increasingly worse in post menopause.

Although it’s most common in postmenopausal women, this condition can also arise in younger women in certain circumstances. For example, breast-feeding can decrease estrogen levels, which can cause this condition. Certain medications that are designed to decrease estrogen levels, like those used to treat endometriosis, can also lead to atrophic vaginitis.

Other causes of lower estrogen levels can include:

  • Chemotherapy.
  • Hormonal therapy for the treatment of breast cancer.
  • Pelvic radiation therapy for the treatment of cancer.
  • Surgical removal of the ovaries.

    Vaginal atrophy cartoon

Atrophic Vaginitis Risk Factors

Some women are at greater risk for developing atrophic vaginitis than others. If you’ve never given birth vaginally, you’ll be more prone to developing this condition after menopause. Women who have undergone at least one vaginal birth are at a much lower risk.

Circulation issues can also make you more likely to develop this condition. Smoking has a negative effect on blood circulation, which deprives your tissues and your vagina of vital oxygen. When blood flow is restricted or decreased, tissue thinning occurs. If you’re a smoker, you’re more likely to develop this condition, and because of your habit, you’ll be less responsive to estrogen therapy.

How to Diagnose Atrophic Vaginitis?

Diagnosing vaginal atrophy can be a complicated task, but the first step is to book an appointment with your doctor.

During your appointment, your doctor will ask you questions about your medical history. You will be asked about when you stopped getting periods and if you’ve had cancer in the past. You may also be asked about any over-the-counter or commercial hygiene products that you use. In some cases, bath products, perfumes, deodorants, soaps and other personal hygiene products can irritate the vagina.

There’s a good chance that your doctor will refer you to a gynecologist for a physical exam and further testing. Your gynecologist will give you a pelvic exam, during which they will palpate your pelvic organs. Physical signs of atrophy will be looked for, which include:

  • Loss of elasticity.
  • Pale, smooth vaginal lining.
  • Smooth and thin external genitalia.
  • Thinning pubic hair.
  • Pelvic organ prolapse.
  • Stretched uterine support tissue.

If your gynecologist identifies any of these physical signs, he or she may order a test to finalize the diagnosis. Tests may include:

  • Vaginal smear test.Naked woman with lily flower
  • Blood test.
  • Vaginal acidity test.
  • Urine test.
  • Pelvic exam.

Smear tests are common, and are relatively simple in nature. The doctor will scrape tissue from your vaginal walls for further examination. This test looks for particular types of bacteria and cells that are commonly seen in women with vaginal atrophy.

A vaginal acidity test can also help your doctor determine whether or not you have this condition. A paper strip indicator will be inserted into your vagina to determine its acidity level. Samples of vaginal secretions may also be collected for testing.

Urine and blood samples may also be requested to check your estrogen levels.

Atrophic Vaginitis Treatment Option

The good news is that women with vaginal atrophy have a number of different treatment options available to them. Treatment will allow you to improve your vaginal health and enjoy your sex life again.

In some cases, doctors will recommend estrogen replacement therapy. Hormonal therapy will improve the elasticity of your vagina and improve lubrication. Typically, estrogen takes just a few weeks to start producing results and can be prescribed in both oral and topical and topical format.

Topical Estrogen

Topical estrogen can come in the form of a cream, ring, or tablet.

Topical estrogen cream
  • Vaginal Ring: Estrogen rings, such as Estring, are soft, flexible rings that are inserted into the vagina by either you or your doctor. This ring provides a constant stream of estrogen, and needs to be replaced every three months. The biggest issue with this treatment is that it provides higher doses of estrogen, which can increase your risk for endometrial cancer.
  • Estrogen Tablet: If you prefer to avoid estrogen rings, you can opt for an estrogen tablet, which is inserted in the vagina with a disposable applicator. To start, tablets are inserted once per day. Over time, you will reduce dosages to once or twice a week.
  • Estrogen Cream: Creams may also be prescribed, and will be inserted into the vagina using an applicator, typically at night. You may be required to insert the cream daily for a few weeks, and then reduce the dose to just 2 to 3 times per week.

Oral Estrogen

During menopause, doctors often prescribe oral estrogen to treat vaginal dryness and hot flashes. The biggest issue with oral estrogen is that it can increase your risk of certain types of cancer. So, if you have had cancer in the past, your doctor will likely not prescribe oral estrogen.

If you don’t have a history of cancer, you may be prescribed with a synthetic progesterone hormone pill in addition to your estrogen pill to keep your hormones balanced.

Although not a life-threatening condition, atrophic vaginitis can be difficult to live with. Not only can it make sexual intercourse painful, but it can also increase your risk of contracting vaginal infections as well as urinary incontinence. If you are experiencing any of the symptoms of atrophic vaginitis, see your doctor right away for a proper diagnosis and treatment plan that works for you.

[Read more about Vagintis]


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