Vaginal Atrophy

Vaginal atrophy, otherwise known as vaginal dryness, urogenital atrophy or genitourinary syndrome of the menopause, occurs when the walls of the vagina thin, and get dry and inflamed. It can feel sore, cause pain during sex and result in bleeding and incontinence. It’s very common, with up to 53% of 52-55 year-olds believed to have symptoms.

You might feel frustrated, in pain, and concerned at its impact on your sex life. However, there are simple steps you can take to ease the discomfort and soreness. Your doctor or online GP can suggest effective treatments to help too.

Hormone Replacement Therapy

What is vaginal atrophy?

Vaginal atrophy is a term used to describe vaginal dryness. In your body, the hormone oestrogen acts as a natural lubricant, keeping the walls of the vagina moist. It also stimulates the presence of the bacteria needed to protect against infection. As you approach menopause, your ovaries produce less of the hormone oestrogen, and vaginal dryness is often the first sign that your oestrogen levels are falling.

As levels of oestrogen continue to drop, the tissue lining of the walls of your vagina get thinner and drier. It can feel inflamed, cause discomfort during sex, start bleeding and affect your ability to orgasm. Some women even find it makes day-to-day living uncomfortable, and feel pain while wearing tampons, sitting or wearing tight clothing.

Vaginal atrophy is part of the rainbow of symptoms of genitourinary syndrome, and is often accompanied by incontinence, itching, pain when peeing and recurrent urinary tract infections (UTIs).

The condition is usually seen in women and people who are peri-menopausal (approaching menopause), going through the menopause, or who are post-menopausal (past menopause).

Menopause is regarded as the point in time 12 months after your last period. If you’d like to check whether you are menopausal, you can order a home test kit.

What are the symptoms of vaginal atrophy?

Vaginal dryness can cause symptoms including:

itching in and around your vagina and vulva.
soreness or pain during or after sex.
a burning sensation or pain when you pee.
bleeding or spotting, particularly after sex.
the need to pee more often.
recurring UTIs.

These symptoms may mean that you might not want to have sex as often as you’d like.

What causes vaginal atrophy?

Vaginal atrophy is most commonly caused by having lower levels of oestrogen.

During your reproductive years, oestrogen keeps the walls of the vagina thick and produces a substance called glycogen, which acts as a natural lubricant. As you approach menopause, your levels of the oestrogen hormone start to fall, which can lead to vaginal atrophy.

Menopause is the most common reason for a drop in oestrogen levels, but hormone fluctuations can also be caused by:

breastfeeding or childbirth
certain kinds of contraception and antidepressants
pelvic radiotherapy
a hysterectomy
some treatments for cancer including chemotherapy

Learn more about the symptoms of low oestrogen

Vaginal atrophy can also affect women whose levels of oestrogen have dropped for other reasons. It might occur in women who are not aroused enough during sex, after repeated use of scented soaps, creams or douches, or in those with diabetes or Sjögren’s syndrome.

How is vaginal atrophy diagnosed?

Vaginal atrophy is usually diagnosed by a doctor. If you’ve had vaginal dryness for a few weeks, it’s affecting your day-to-day life, and home treatments aren’t working, then you should see your GP or speak to an online doctor. You should also speak to a doctor if you have unusual discharge or bleeding in between periods or after sex.

The doctor will talk to you about your symptoms and give you a pelvic examination, which will involve feeling your pelvic organs and examining your vulva, vagina and cervix. They may also carry out a pH test to determine the level of acidity in your vagina, and swab tests to rule out the possibility of infections. If you have urinary symptoms, your GP may also carry out a urine test.

How to treat vaginal atrophy

Vaginal atrophy is a long-term condition, and symptoms will not go away if they remain untreated. However, there are many effective options that include home remedies and lifestyle changes, non-hormonal treatments and hormone-based treatments such as Hormone Replacement Therapy (HRT).

How can I treat vaginal dryness at home?

To relieve symptoms of vaginal dryness at home try:

using unperfumed soaps, washes, shower gels and shaving foams
avoiding using douches
increasing the amount of time you and your partner spend on foreplay
using water-based lubricants before or during sex
using moisturisers specifically formulated for your vagina (never use anything not explicitly designed for the purpose)
avoiding putting any creams or lotions into your vagina that are not formulated for that purpose

You can buy certain products over the counter or online from Superdrug without prescription. If they don’t provide relief and you still have symptoms, you should visit your GP or speak to your online doctor.

What treatments do GPs and online doctors offer?

GPs and online doctors can offer two treatment options:

Topical oestrogen treatment

Topical oestrogen treatments (also known as local HRT) are creams, gels and pessaries that you apply directly to, or near the affected area and that contain oestrogen. They are considered to be safer than other forms of HRT but do not help with symptoms such as hot flushes or protect against long-term menopause symptoms such as osteoporosis.

They include:

Creams

Oestrogen creams include Estriol and Ovestin. They contain the hormone estriol and are applied daily using an applicator. The creams can relieve symptoms such as itching, dryness and irritation in 3-6 weeks. Blissel gel is an alternative treatment that contains estriol.

Estriol is the weakest of the three oestrogen types – it’s less likely to cause side-effects and may be safer than the stronger estradiol.

Pessaries

Pessaries such as Vagifem contain a form of oestrogen called estradiol, which is stronger than the estriol found in Estriol creams. They are inserted into the vagina using an applicator.

If you choose Vagifem, you will usually administer a tablet daily for the first two weeks, then twice weekly after that. You should start feeling the effects of the treatment within 8 weeks. They are the most common choice of topical oestrogen treatment.

Other pessaries include the lower dose Imvaggis, which contains estriol and requires no applicator (more environmentally friendly) and Intrarosa, which contains prasterone, also known as DHEA, a hormone that is biologically identical to a hormone produced by our bodies. Alternatively, Gina is a local HRT low-dose oestrogen tablet that’s inserted into your vagina and is available without prescription.

Vaginal rings

Oestrogen rings such as Estring are inserted by a health professional. They sit inside your vagina and release a slow and steady dose of estradiol, at a slightly higher dose than Vagifem. Rings are replaced every three months.

Which are more effective: Creams containing estriol, or pessaries and rings whose active ingredient is estradiol?

Studies show pessaries containing estriol or estradiol to be equally effective. However, estriol (contained in Estriol and Ovestin) is considered to cause fewer side-effects than estradiol (contained in Vagifem).

Find out more about topical vaginal dryness treatments.

Hormone Replacement Therapy (HRT)

Hormone replacement therapies relieve symptoms by replacing the hormones that decline as you approach the menopause. HRT treats all symptoms of the menopause, including vaginal dryness. In order to start HRT, you need to get a prescription. You will start at a low dose, which may be slowly increased. Treatments can take up to 3 months to be effective.

What kind of hormone replacement therapies are there?

There are many different kinds of HRT and it may take some time to find the right treatment for you. You may take an oestrogen-only HRT or one that includes both oestrogen and a progestogen.

Forms of HRT can include

Tablets

Tablets like Elleste Duet Conti and Premique are taken daily.

They contain oestrogen and progesterone.
They are only available with a prescription.
They can increase your risk of blood clots.

Skin patches

Skin patches such as Evorel Conti release oestrogen and progestogen into your blood stream.

They are worn constantly and should be replaced two times a week.
They take up to 2 to 3 months to start working.
They are a good option if you find it inconvenient to take a tablet every day.
They do not increase your risk of blood clots.

Gels

Oestrogen gels are rubbed directly into your skin.

You will need to take progestogen separately if you still have a womb, to reduce the risk of cancer.
They do not increase your risk of blood clots.

Implants

Implants are inserted under your skin by a health professional and last several months.

They are suitable if you find it inconvenient to take a daily tablet.
If you still have a womb, you will have to take a separate progestogen tablet to reduce the risk of cancer.
They can take 2 to 3 months to show results.

Implants are not a common choice of HRT delivery.

You may not be suitable for HRT if you: