I get a number of queries from women at Menopause who are concerned about vaginal atrophy, or not sure if they are just suffering from the dryness that is much more common at this time.

Vaginal atrophy is when the walls of your vagina get thin, dry, and inflamed. This can happen when your body makes less oestrogen, such as during and after menopause.

Symptoms you may notice

This condition and its symptoms together can be noticed in both your vagina and urinary tract. You may have:

– Vaginal dryness or burning

– Itching in your genitals

– Unusual vaginal discharge

– More yeast infections

– Burning when you pee

– A need to pee often

– A hard time holding pee in (incontinence)

– More urinary tract infections (UTIs)

– Discomfort or bleeding during or after sex

– Less natural lubrication when you have sex

Dryness is usually the first sign that women notice and can occur at perimenopause as well as menopause have them after menopause.

It is estimated that up to 40% of women after menopause have symptoms.

Why does it happen?

The cause of vaginal atrophy is a drop in oestrogen levels. At menopause both progesterone and oestrogen levels fall dramatically.

When your body has less oestrogen, your genital tissues become more fragile. Menopause is the most common reason, but levels can also go down because of:

– Breastfeeding

– Anti-oestrogen medications

– Some birth control pills

– Surgery to remove both ovaries

– Chemotherapy

– Pelvic radiation therapy

– Hormone treatment

How is it diagnosed?

Your doctor will use three methods to diagnose the condition:

1   Urine test. Your doctor will get a urine sample for testing, especially if you have urinary issues.

2.  Pelvic exam. Your doctor will look closely at your genitals and feel inside to check your cervix.

3.  Acid balance test. For this test, your doctor may use a paper strip to check the acid balance in your vagina.

Risk Factors

There are two main things that can raise your chances of vaginal atrophy and GSM.

Smoking because it restricts blood flow, including to your vaginal area. It also lowers the natural amount of oestrogen in your body.

Caesarean births as women who haven’t had a vaginal birth are more likely to have  issues than those who have.

Treatment options 

One way is to be having regular sexual activity, by themselves or with a partner, as that tend to mean milder cases of vaginal atrophy than those who don’t. Sexual activity raises blood flow to the vagina and helps it stay elastic.

If you just suffer dryness and discomfort, especially when you have sex, vaginal moisturizers or water-based lubricants may help. You use them every few days and just before intercourse.

Bioidentical progesterone cream used vaginally can help with dryness, as can a combination cream with both progesterone and natural oestrogens.

If however you are diagnosed with atrophy, rather than dryness then what is usually recommended is a separate oestrogen source applied locally. It can thicken your vaginal walls and ease many of the other symptoms too.

Generally oestrogen used locally is one of the safest ways to do so, and you may be offered a cream or suppository or a soft ring form.

There may be side effects, so talk with your doctor and many women choose to balance this form of oestrogen with bioidentical progesterone. to see what’s right for you.

Helpful information 

As well as maintaining good levels of oestrogen and progesterone for hormone balance, there are some simple measures you can also take to help yourself.

If you have dryness, itching, or burning, don’t use perfumes, scented lotion, deodorants, or powders on your pelvic area.

Only use unscented soap, and some panty liners and pads may add to the irritation because they contain synthetic material.

Look for organic sources and don’t wear tights, or body shapers that restrict circulation and air flow.