Vaginal atrophy occurs when the lining of the vagina becomes dry and thin, leading to problems such as itching, burning, and pain during sex. It is caused by a drop in oestrogen levels around the time of menopause. It’s also common to develop urinary (wee) symptoms including urinary leakage and recurrent urinary tract infections (UTIs). Because the condition causes vaginal, urinary and sexual symptoms, and occurs around or after menopause, vaginal atrophy is also known as genitourinary syndrome of menopause (GSM).
What is vaginal atrophy?
What causes vaginal atrophy?
What are the signs and symptoms of vaginal atrophy?
Who is at risk of developing vaginal atrophy?
How is vaginal atrophy diagnosed?
Complications of vaginal atrophy
Treatment for vaginal atrophy
Prevention of vaginal atrophy
When to see your doctor
What you can do
Around the time of menopause, women experience changes to the vagina and urinary (wee) system that is caused by decreased levels of the hormone oestrogen in the body. These changes are described as vaginal atrophy — also known as genitourinary syndrome of menopause (GSM). Vaginal atrophy affects around 40% of postmenopausal women and the risk increases with age.
Low levels of oestrogen cause thinning of the vaginal lining, vulval skin, bladder, urethra (the tube that leads from the bladder to outside the body) and the pelvic floor muscles. This can cause symptoms in these areas and reduced blood flow in the pelvis. However, treatment for vaginal atrophy and other tissues can be very effective, so if you experience any of the symptoms, speak to your doctor.
The vagina (and other tissues in the pelvis) needs oestrogen to keep the tissue healthy. When oestrogen levels drop, vaginal tissues become less plump and elastic. Instead, they become drier, thinner and more fragile. This increases the risk of irritation or abrasions that encourage infection of the urinary tract.
Oestrogen levels start to rise and fall unevenly during perimenopause (the years leading up to menopause) and they fall further after menopause (the final menstrual period). Oestrogen levels may also decrease due to:
Vaginal symptoms include:
Urinary (wee) system symptoms include:
The risk of UTIs also increases as we age. Weakened pelvic floor muscles can lead to more frequent urination that is difficult to control. If the bladder doesn’t completely empty, a ‘pool’ of urine may be left behind which can lead to infection. The vagina becomes less acidic after menopause and this also increases the risk of urinary tract infections (UTIs). Weakened pelvic floor muscles may lead to urinary leakage especially with actions like coughing, sneezing or laughing.
Women over 50 years of age or who have gone through menopause are most likely to develop vaginal atrophy. However, other factors that increase your risk include:
Your doctor will ask questions about your symptoms, past health history and family health history. A physical examination will include a pelvic examination to check your vulva and vagina for signs of vaginal atrophy. If there is vaginal discharge, your doctor may take a vaginal swab to check for any infection. If you have urinary symptoms, your doctor may also order a urine test to check for a UTI.
The vagina becomes less acidic after menopause and these changes can mean that bacteria and other organisms are more likely to grow and thrive. This can increase your risk of developing vaginal infections. Urinary changes linked to vaginal atrophy can increase the likelihood of urinary tract infections and urinary incontinence.
Treatment for vaginal atrophy can involve non-hormonal and hormonal options.
Vaginal oestrogens, available as tablets, pessaries or creams, are an effective treatment for vaginal atrophy. They deliver oestrogen directly to the vagina without raising oestrogen levels in the rest of the body. Vaginal oestrogen treatment improves blood flow in the pelvis and increases vaginal secretions.
Oestrogen creams come with an applicator, but many women find it easier to apply the cream to their finger and insert it into their vagina. Any excess can be smeared onto the skin of the vulva. It is recommended to insert the oestrogen only into the lower third of your vagina (about 2-3 cm). This will improve the tissues of the pelvis: the vulva, vagina, bladder, urethra and pelvic floor muscles.
Menopausal hormone therapy (MHT) will also improve vaginal symptoms and can be used if women are also experiencing menopause symptoms that affect the whole body such as hot flushes and night sweats. Ask your doctor if MHT is appropriate for you.
Hormonal treatment may not be suitable for women with a history of oestrogen receptor positive cancer. Discuss your risk factors with your doctor.
Regular sexual activity (with or without a partner) may help prevent vaginal atrophy. Sexual activity improves blood flow to the vagina which helps keep vaginal tissues elastic and flexible. Sexually active women report fewer symptoms of vaginal atrophy compared to women who don’t have regular sex.
Many women experience the symptoms of vaginal atrophy but don’t seek treatment because they feel embarrassed. Others think there is nothing that can be done and that they just have to ‘grin and bear it’. If you experience any of the signs or symptoms mentioned, make an appointment with your doctor because treatment can be very effective. If pain, irritation or other symptoms continue after treatment, please see your doctor to check for another cause.
Reducing vaginal irritation can help with some of the symptoms of vaginal atrophy. These recommendations may help:
Visit our webpage on Vaginal irritation for more information.
Find out what’s normal when it comes to vulval health, what causes irritation, how it can be managed and handy health tips to keep in mind.
This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at October 2021.
