Harvard Women's Health Watch

Managing postmenopausal vaginal atrophy

Vaginal dryness is one of the most irritating symptoms of menopause. Here are some ways to relieve it.

Within a few years of menopause, roughly 50% of women develop symptoms related to vaginal atrophy, also called atrophic vaginitis — the deterioration of vaginal tissues due to loss of estrogen. The most common symptoms are dryness, irritation, and pain during intercourse. Although menopause is the most common cause, vaginal atrophy can result from anything that lowers estrogen production. That includes chemotherapy, radiation, removal of the ovaries during hysterectomy, and use of anti-estrogenic therapies such as aromatase inhibitors, tamoxifen (Nolvadex), and drugs like leuprolide (Lupron) and nafarelin (Synarel), which are used to treat fibroids and endometriosis. Unlike hot flashes, which usually subside with time, vaginal atrophy is likely to persist and become worse without treatment.

Loss of estrogen decreases blood flow to the vagina, causing vaginal tissue to become thinner, drier, and less elastic. The top layer of the epithelium (the cells lining the vagina) may be entirely lost, leaving the layer below vulnerable to inflammation, infection, or trauma when it's exposed to any pressure, including sexual activity, a Pap smear, or the insertion of a speculum. The vaginal environment becomes less acidic, reducing the number of beneficial flora (lactobacilli) and encouraging the growth of organisms that cause vaginal and urinary tract infections. As vaginal secretions decline, sexual intercourse can become more painful and may be followed by bleeding or spotting. Other common symptoms are itching, burning, and discharge.

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