According to the American Association of Family Physicians, around 40% of women suffer from vaginal atrophy post-menopause. In a British Menopause Society survey 35% of women said they had experienced vaginal dryness, with 18% of those who had this symptom saying it was unexpected.
The symptoms are enough to ruin anyone’s day – vaginal dryness, thinner and drier vaginal tissues, vaginal discharge, soreness and itchiness are among the most common. And not only that, they can interfere with relationships by making sexual intercourse less enjoyable, get in the way of your plans, and make you change the way you dress to avoid chafing against now sensitive areas.
But what actually is vaginal atrophy, what causes it, and what can you do to treat vaginal dryness and keep symptoms at bay? We’ve rounded up all the answers here.
First, what is menopause?
Menopause is the period in a woman’s life when her menstrual bleeding stops. It usually happens between the ages of 50 and 55 and is caused by a decline in the hormone levels produced by the ovaries – oestrogen ( estrogen) , testosterone and progesterone. A woman in menopause no longer has monthly bleeding. Typical menopausal symptoms include hot flashes, brain fog, night sweats and vaginal and urinary symptoms.
What is vaginal atrophy?
Vaginal atrophy – sometimes called atrophic vaginitis. Genitourinary syndrome of menopause (GSM) is a wider encompassing term which includes conditions of the vulva, the vagina and pelvic floor tissues, the urinary tract and sexual dysfunction ( or low libido).
Vaginal atrophy is when vaginal tissue thins and becomes drier which results in vaginal dryness. The thinning of the bladder and urethra tissues can cause urinary symptoms which means you also have less bladder control and need to go to the toilet more often or more urgently.
Many women are too shy to report these symptoms to their GP and uncomfortable symptoms can go on for years before a vaginal atrophy diagnosis.
What causes vaginal atrophy?
Healthy vaginal tissue relies on the hormone oestrogen for natural vaginal lubrication. When the ovaries are no longer producing oestrogen at the end of a woman's childbearing years, the vagina, vaginal canal, vulva and bladder start to dry out and this can cause vaginal infections and vaginal discomfort. Oestrogen also protects the vagina from infection.
Who is at risk for getting vaginal atrophy (GSM)?
Menopausal women and post menopausal women are at risk of getting symptoms of vaginal atrophy and wider genitourinary syndrome of menopause. However, symptoms of vaginal dryness can start when a woman is still bleeding and perimenopause is ending when oestrogen levels fluctuate.
Symptoms of vaginal dryness
When your oestrogen levels fall, your vagina can become very dry and sore due to less estrogen. Some of the first symptoms women notice is discomfort during sex, difficulty inserting tampons ( the vagina can start to change before a woman officially becomes menopausal) and tenderness when using toilet paper after using the bathroom.
Painful sexual intercourse
With vaginal atrophy, sex can become uncomfortable and sometimes even painful. Oestrogen supports vaginal lubrication and keeps the vagina walls, vaginal canal and vaginal area supple and flexible.
When oestrogen levels drop, the tissue becomes thinner and less stretchy and vaginal fluids reduce which leads to painful intercourse. Not only that, but the clitoris can actually shrink due to low oestrogen levels, making sexual activity less enjoyable.
Vaginal itching isn’t just uncomfortable – it’s embarrassing and can really interfere with your day. Itching can manifest both inside and outside of the vagina as tissues start to dry out.
Bleeding and spotting
Bleeding and spotting are common symptoms of atrophy, particularly after sexual activity. It happens as a result of inflammation due to friction against the thinning tissue of the vaginal walls and a lack of natural vaginal moisturisers.
More urinary tract infections
Oestrogen helps keep the vagina’s pH balance in check, so things are thrown out of whack when levels plummet. This sometimes results in more urinary tract infections such as cystitis, because the vagina’s ability to fight off bacteria is reduced. The main symptoms of urinary tract infections (UTI's) are urinating more often and a stinging or burning sensation when you urinate.
Another of oestrogen’s functions is to keep the bladder in good shape. Without enough oestrogen, the bladder can become weak, leading to symptoms like stress incontinence, or feeling like you need to urinate more urgently and more often.
Occasionally, vaginal atrophy can lead to vaginal prolapse. a feeling of heaviness around your lower tummy and genitals. This is when the top of the vagina weakens and drops, causing the vagina to shift downwards. It can feel like something heavy is pressing on your vagina from the inside, and in some cases, a bulge can be seen or felt.
Treatments for vaginal atrophy
There are vaginal treatments that can be prescribed or bought over the counter in the form of pessaries, creams or vaginal rings.
One way of addressing atrophic vaginitis is vaginal estrogen therapy. You can get vaginal oestrogen on prescription, or buy it over the counter in a pharmacy. It’s a form of HRT suitable for women who are need of additional support for vaginal symptoms
Unlike other forms of estrogen therapy it specifically targets the symptoms of vaginal dryness in the vagina. Vaginal estrogen therapy comes in the form of tablets, which you insert into the vagina with the help of an applicator. It’s also available as a vaginal cream to treat itching and dryness.
It’s important to note that vaginal oestrogen only treats vaginal symptoms of menopause – it’s not absorbed into the rest of the body like systemic estrogen therapy, so it comes without the risk of complications like blood clots.
Vaginal oestrogen also needs to be applied a twice a week. If you have advanced vaginal atrophy your doctor may start you on a more intense regime with a more intense regime of vaginal oestrogen therapy to help treat your vaginal discomfort and then put you on a maintenance program.
Vaginal moisturizers can help ease certain symptoms of vaginal atrophy – particularly those related to dryness, such as painful sex. These are readily available to buy over the counter, but they aren’t always effective. Plus, they will only treat the symptoms of vaginal dryness, need to be used daily – they won’t target the cause.
Vaginal rings are another HRT delivery system. They are inserted into the vagina and release a form of oestrogen called estradiol which is released continually at a gradual rate. This oestrogen is released locally in the vagina and helps to maintain adequate levels of oestrogen which help to relieve dryness and make the vaginal canal and walls more flexible and moisturised. Rings can last for up to 90 days.
There are certain exercises you can do to strengthen your pelvic floor, which can help combat things like incontinence and bladder weakness, and prevent vaginal prolapse. Kegel exercises increase blood flow to the vaginal tissue, aiding lubrication.
The idea is to contract the group of muscles in your lower pelvis, just like you would if you were stopping urine flow – you can do this anywhere, either while standing, sitting up or lying down. Or, if you prefer, you can buy exercisers like the Elvie Trainer – a device that you insert into your vagina, that then guides you through a set of exercises via an app.
When should I see seek treatment for vaginal atrophy?
You should see your doctor if you see any of the early symptoms of vaginal dryness which include painful sex, spotting, an increase in UTI's, sensitivity or itching.
The bottom line
Vaginal atrophy can be a real burden for women. Symptoms like dryness, soreness and itching have the ability to ruin relationships and stop you from living your life to the full. Thankfully, there are solutions available, like localised vaginal oestrogen, vaginal moisturizer and pelvic floor exercises.
Does menopause cause vaginal prolapse?
Vaginal prolapse – when the top of the vagina weakens and slips from its usual location – can sometimes be caused by falling oestrogen levels in menopause.
How do you get rid of dry vaginal skin?
If you’re suffering from vaginal dryness due to low estrogen levels, hormonal treatments work best. You can try topical estrogen creams or vaginal suppositories, which are available on prescription and to buy in pharmacies.
What are the most common vaginal atrophy symptoms?
Vaginal dryness, soreness and itching are some of the most common signs of vaginal atrophy. Urinary problems, such as cystitis and incontinence, can also be symptoms.