Vaginal atrophy or atrophic vaginitis, as it's clinically defined, is a set of symptoms that includes vaginal dryness, persistent burning, irritation and painful sex. These symptoms are an all too common part of life during and after menopause: roughly 50% of women experience vaginal atrophy within a few years of having their last period.1 Although vaginal atrophy typically occurs after menopause2, some women who have never had issues with vaginal dryness may start to experience symptoms during perimenopause. The use of vaginal lubricants is often the first response to dryness, but this only delivers a temporary solution to an issue that could respond better to more consistent treatment.
The good news is that you have several treatment options for vaginal atrophy, including systemic HRT, vaginal hormones or steroids, or hormone-free vaginal inserts that can be recommended based on your symptoms and preferences. Below, we’ve tapped Bonafide's Chief Medical Officer, Dr. Alyssa Dweck, to give you more insight on what you need to know about vaginal atrophy, including menopausal vaginal dryness, and your options for managing and preventing further symptoms.
Vaginal Atrophy Symptoms and Causes
Although vaginal atrophy and vaginal dryness refer to the thinning of the internal tissues of the vagina, atrophy can affect a much broader area, including the vulvar (external) skin. "Both the vagina and vulva are affected by estrogen deficiency, so much so that the term “vaginal atrophy” has essentially been replaced by the broader term GSM or genitourinary syndrome of menopause. This verbiage was meant to be inclusive of all genital changes caused by diminished estrogen levels," explains Dr. Dweck.
Other areas that can be affected by menopausal hormonal changes include the labia, introitus (vaginal opening), clitoris, bladder, and urethra. "Common vulvar symptoms include vulvar dryness, irritation and burning, urinary discomfort (dysuria), frequency, urgency and recurrent UTIs, and sexual symptoms, including pain," says Dr. Dweck.
Although all of the above symptoms can be attributed to menopausal vaginal atrophy, they can sometimes be caused by other issues, which is why it's important to check in with your healthcare provider first to rule out infection or a skin condition, according to Dr. Dweck.
Risks Associated With Vaginal Atrophy
Besides experiencing unpleasant or painful symptoms, when vaginal atrophy or GSM is left untreated, it can lead to other risks. "The risk of infection, including urinary tract infections, is elevated with GSM. The risk of BV (bacterial vaginosis) is elevated with untreated, unmanaged vulvovaginal atrophy since the vaginal pH can become more alkaline during menopause," says Dr. Dweck. "Perineal fissures (tiny vulvar micro abrasions) can form and cause discomfort day to day or with exercise. Bleeding from external irritation of delicate tissue can also occur," says Dr. Dweck.
How and When to Get Treatment for Vaginal Atrophy
Vaginal atrophy can be reversed when treated properly. "Cellular tissue changes due to diminished estrogen can be reversed," says Dr. Dweck. Because the vaginal changes are due to diminished estrogen, some people may try estrogen or hormone therapy. But for those who decide not to use hormones, hyaluronic acid is a non-hormonal treatment option. "Studies suggest that hyaluronic acid applied topically to the vagina on a regular basis can reverse tissue changes similarly to vaginal estrogen," says Dr. Dweck.
Revaree® is a vaginal insert that contains hyaluronic acid, which Dr. Dweck recommends using as part of a regular moisturizing regime. Other prescription or in-office options include estrogen, DHEA inserts, ospemifene and surgical remedies. "Risks and indications for these must be considered individually," says Dr. Dweck.
Other Tips for Managing Vaginal Atrophy
Have sex: Dr. Dweck encourages sexual play, either with a partner or alone. Sexual activity increases blood flow to the genitals, which helps maintain healthy vaginal tissue.
Choose hygiene and personal products wisely: "Some may need to use fragrance and dye-free soaps, detergents and fabric softeners, especially on undergarments. I usually suggest trialing 100% organic cotton pads and liners if applicable and 100% cotton panty crotch material," says Dr. Dweck.