Atrophic Vaginitis – Causes, Symptoms & Treatment of Vaginal Atrophy

Atrophic vaginitis is an inflammatory condition affecting many women – and not infrequently they suffer in silence, carrying a heavy emotional burden. Yet there is nothing shameful or embarrassing about it: it is a natural process that occurs either with age or as a result of treatments that trigger hormonal fluctuations.

If this intimate discomfort is familiar to you, it's important to know that you are not alone, and there are solutions. In this article we explain what vaginal atrophy is, how it develops and how you can treat it – so that you can better understand the changes in your body and cope with them more easily.

What is atrophic vaginitis? 

Atrophic vaginitis is a form of genitourinary syndrome that occurs as a result of falling oestrogen levels associated with the menopause and certain treatments.

Oestrogen is a key female hormone that supports the elasticity and health of vaginal tissue. When oestrogen levels in the body fall, vaginal tissue loses its elasticity, becomes dry and thinner, and becomes inflamed. This condition is known as atrophic vaginitis or vaginal atrophy, and it causes discomfort, pain during intercourse and even vaginal bleeding.

Atrophic vaginitis – causes 

Falling oestrogen levels in the body are the main cause of atrophic vaginitis. Several factors may be responsible for this fluctuation.

Falling oestrogen levels after the menopause

The menopause is the phenomenon most commonly associated with declining oestrogen levels and the onset of atrophic vaginitis. It is a normal stage in every woman's life, beginning roughly between the ages of 40 and 55, and marks the end of ovarian function and menstruation.

Throughout a woman's reproductive life, the ovaries produce oestrogen and progesterone, the female sex hormones. During the menopause they naturally cease hormone production, which is why oestrogen levels fall and thinning of the vaginal tissue may occur.

Women who develop atrophic vaginitis due to falling oestrogen levels after the menopause struggle with vaginal dryness, dyspareunia and even light discharge or light vaginal bleeding, which makes the use of panty liners necessary.

Oophorectomy  

Ovarian function may end for natural reasons such as the menopause, but also as a result of certain treatments and procedures. Oophorectomy is one such procedure.

An oophorectomy is the surgical removal of the ovaries, which may be recommended to treat ovarian cysts, to manage endometriosis or even to prevent ovarian cancer. Without ovaries to continue producing oestrogen, levels in the body fall and may trigger atrophic vaginitis.

Chemotherapy or hormone therapy for breast cancer 

Chemotherapy targets cancer cells, but it can also damage healthy cells in the ovaries and thereby inhibit oestrogen production. Similarly, hormone therapy for breast cancer can lower oestrogen levels and block receptors in order to slow the growth of cancer cells.

Both cancer treatments cause oestrogen levels in the body to decline and may result in a loss of elasticity and drying of the vaginal tissue.

Breastfeeding 

Breastfeeding prompts the body to produce larger amounts of prolactin. Raised prolactin levels, however, can inhibit ovulation and oestrogen production, leading to a temporary drop in oestrogen levels in the body.

Certain medications 

There are other treatments frequently associated with vaginal atrophy. Certain medications, such as those for endometriosis or uterine fibroids, suppress oestrogen production or block its action – this can lead to drying of the vaginal lining and vaginal atrophy.

Ovarian insufficiency 

Ovarian insufficiency is a condition in which ovarian function ceases prematurely – before the age of 40 – with symptoms typically associated with the menopause. In short, the ovaries do not produce enough oestrogen and progesterone to maintain the menstrual cycle, resulting in infertility and vaginal atrophy. 

Amenorrhoea 

Amenorrhoea means the absence of menstruation and can be an indirect cause of atrophic vaginitis. The same factors that trigger amenorrhoea – such as excessive physical training or anorexia – can also lower the oestrogen levels responsible for vaginal atrophy.

Untreated diabetes 

The raised blood sugar levels seen in untreated diabetes encourage inflammation and impair blood circulation – making it a possible cause of loss of elasticity in vaginal tissue. Diabetes also increases the risk of vaginal infections, which can further heighten intimate discomfort.

Stress 

Chronic stress upsets the balance of the entire body, including hormonal balance and oestrogen levels. Prolonged periods of stress also lead to muscle tension and loss of natural vaginal lubrication. All these changes can worsen the symptoms of vaginal atrophy.

Depression 

Antidepressants are a common cause of vaginal dryness. Depression itself can affect hormone levels and reduce sexual desire, intensifying the discomfort typical of atrophy.

Risk factors for atrophic vaginitis (vaginal atrophy) 

As hormonal fluctuations are the main cause of atrophic vaginitis, the risk factors are generally those that can negatively affect oestrogen production and vaginal health:

• Smoking (can affect how the body handles oestrogen levels and reduce blood supply to the pelvic organs).
• Never having had a vaginal birth (women who have not given birth naturally are more prone to atrophic vaginitis)
• Long-term treatment with medications that lower oestrogen levels
• Taking certain contraceptive pills
• Lack of regular sexual activity
• Recurrent vulvovaginitis
• Use of tampons

Atrophic vaginitis – symptoms – how does atrophic vaginitis present? 

Atrophic vaginitis is characterised by thinning and drying of the vaginal tissue, loss of elasticity and the development of inflammation. All these changes manifest through symptoms such as:

• Vaginal dryness and persistent discomfort
• Itching and burning in the vaginal area or urethra
• A feeling of pressure or pain in the vaginal or pelvic area
• Thinning and paling of the vaginal and vulval tissue
• Dyspareunia, or pain during intercourse due to a lack of natural lubrication
• Vaginal stenosis, or scarring and narrowing of the vaginal canal
• Light, watery vaginal discharge
• Light vaginal bleeding, particularly after intercourse, which can cause micro-tears in the dry vaginal tissue
• Persistent and sudden urge to urinate
• Urinary incontinence
• Frequent urinary tract infections, as falling oestrogen levels can disrupt the balance of the vaginal flora

Possible risks and complications of atrophic vaginitis 

Without a correct diagnosis and treatment, the symptoms of atrophic vaginitis worsen and can lead to various complications:

• Severe pain during intercourse may lead to avoiding intimacy and one's partner.
• Narrowing of the vaginal canal in severe atrophy can cause intense pain during intercourse and make a gynaecological examination impossible.
• Recurrent urinary tract infections, bacterial vaginosis or other vaginal infections.
• Inflammation of the bladder, burning and pain when urinating, even urinary incontinence.
• Stenosis, tears or fissures of the vagina.

How is atrophic vaginitis (vaginal atrophy) diagnosed? 

A gynaecologist can diagnose atrophic vaginitis based on symptoms and a gynaecological examination, during which signs of atrophy of the vagina and cervix are visible: redness, inflammation, dryness, discolouration of the vagina, micro-tears near the vaginal opening, a narrowed vaginal canal and reduced labia.

To confirm the diagnosis, the full set of investigations may include:

• The patient's medical history (the doctor may ask whether your menopause has begun, whether you take certain medications, have recently given birth, experience pain during intercourse, or have noticed bleeding, spotting, unusual discharge or other atypical symptoms)
• Gynaecological examination (to assess the signs of atrophic vaginitis)
• Measurement of the pH of vaginal secretions
• The smear test (cervical screening)
• Urine samples
• Vaginal swab (microscopic examination of a sample of vaginal or cervical secretions)
• Blood tests

Treatment of atrophic vaginitis (vaginal atrophy) 

Your doctor may prescribe both hormonal and non-hormonal treatments for vaginal atrophy. The aim is to restore the elasticity and natural lubrication of the vaginal tissue in order to ease symptoms and reduce discomfort.

Local therapy with topical oestrogens  

Local therapy treats the symptoms of atrophic vaginitis without raising oestrogen levels in the blood. These topical oestrogens may come in the following forms:

• Creams and pessaries, which you insert into the vagina daily for a few weeks and then continue using 2 to 3 times a week.
• A thin, flexible ring, which the doctor inserts into the vagina and replaces every three months.
• Oestrogen spray, which you apply to the skin of the forearm.
• Oestrogen ointments, which you apply to the skin of the forearm or breasts.

Systemic oestrogen therapy 

Systemic oestrogen therapy may take the form of tablets, gel, creams, sprays or patches. The oestrogen is released into the bloodstream and distributed throughout the body.

Doctors recommend this treatment for women with multiple menopausal symptoms, including hot flushes, sleep disturbances and mood swings.

Lubricants and moisturising lotions 

Lubricants and moisturising lotions are non-hormonal treatments recommended for women with vaginal atrophy to reduce dryness and provide moisture to the vaginal tissue.

Natural water-based lubricants provide moisture, reduce friction during penetration and prevent micro-tears that cause bleeding; moisturising lotions can be used regularly to maintain vaginal moisture.

Vaginal laser rejuvenation 

Another non-hormonal, non-invasive treatment option could be vaginal laser rejuvenation. It uses laser energy to stimulate collagen production, which helps regenerate the vaginal tissue and improves its elasticity. At present, however, there are not yet enough long-term studies to confirm the effectiveness of this treatment for vaginal atrophy.

Vaginal rejuvenation with PRP

Vaginal rejuvenation with platelet-rich plasma (PRP), also known as the VAMPIRE therapy, is based on injecting platelets and growth factors obtained from your own blood – with no other additives. The treatment can be used therapeutically for vaginal atrophy and may stimulate neovascularisation (the formation of new blood vessels) and regeneration of the vaginal lining.

Vaginal dilators 

If vaginal atrophy has led to narrowing of the vaginal canal, your doctor may recommend the use of vaginal dilators. These devices stretch the vagina and increase patients' comfort during intercourse. You usually start with a small dilator and move on to progressively larger sizes as your comfort increases.

How can atrophic vaginitis be prevented? 

The menopause, the end of ovarian function, falling oestrogen levels – all of this is a natural and normal part of a woman's life as she gets older. These processes cannot be prevented, as they follow the natural course of things.

There are, however, steps you can take to keep the symptoms of vaginal atrophy under control, avoid complications and continue leading a normal life:

• Avoid smoking and other harmful habits that can lower oestrogen levels.
• Use organic menstrual products and natural intimate care products free from fragrances and other irritating substances that can upset the balance of the intimate flora and encourage local inflammation.
• Bear in mind that regular sexual activity promotes blood supply to the intimate area and is an effective way of preventing vaginal atrophy.
• Use a water-based lubricant with 100% natural ingredients so that you can enjoy intercourse without the discomfort caused by dryness and friction.
• Talk to your doctor about the possibility of oestrogen therapy during the menopause to prevent vaginal atrophy.
• Eat a balanced diet and drink plenty of fluids.
• Do Kegel exercises: they strengthen the pelvic floor muscles and improve blood circulation in the vaginal area.
• Attend regular gynaecological check-ups so that early signs of vaginal atrophy are picked up in good time, and follow your doctor's advice to prevent the condition from worsening.

Frequently asked questions about atrophic vaginitis

Although atrophic vaginitis is a common condition, it often remains hidden and is rarely discussed. Vaginal health, however, has a major impact on a woman's quality of life and should not be ignored. Particularly in the context of hormonal changes as natural as those of the menopause, it is important to understand how your body works and how you can support it.

Below we answer the most common questions about vaginal atrophy, its causes, symptoms and treatment options, so that you can continue to live a normal life free from discomfort.

How common is atrophic vaginitis in menopausal women? 

Atrophic vaginitis is a common condition that usually occurs after the age of 40. Studies show that 50 to 85% of menopausal women are affected.

Even though it is caused by the natural decline in oestrogen levels, atrophic vaginitis is not a normal symptom of ageing. It's important to know that there are effective solutions and treatments to relieve the discomfort.

Can atrophic vaginitis also occur in younger women?

Yes, atrophic vaginitis can also occur before the menopause in young women if there are other causes of falling oestrogen levels. This can happen during breastfeeding, with certain health problems (endocrine disorders, diabetes, depression, ovarian insufficiency) or as a result of certain medical treatments (chemotherapy, antidepressants, oophorectomy, hormone therapy).

How long does it take for treatment of atrophic vaginitis to work? 

The effectiveness of treatment depends on the method chosen. Lubricants and moisturising lotions can relieve discomfort immediately, while hormonal and non-hormonal local therapies need to be used daily for several weeks before a visible improvement occurs.

Does atrophic vaginitis affect fertility? 

Atrophic vaginitis itself does not cause infertility. However, if it is due to falling oestrogen levels – during the menopause or with ovarian insufficiency – vaginal atrophy occurs under conditions in which the body does not produce enough sex hormones and ovulation does not take place. And that directly affects fertility.

The symptoms associated with atrophic vaginitis, such as dryness, discomfort and pain during intercourse, can also have a negative impact on your intimate life, reducing the frequency of sexual contact and therefore the chances of conceiving.

What influence does cancer treatment have on the risk of atrophic vaginitis? 

Even though their aim is to destroy cancer cells, cancer treatments can also damage healthy cells in the ovaries and significantly reduce oestrogen production. This can encourage the onset of atrophic vaginitis – but there are solutions tailored specifically to women with a history of cancer.

What role does sexual activity play in preventing atrophic vaginitis? 

Regular sexual activity can stimulate blood supply to the vaginal tissue and natural lubrication, helps maintain elasticity and thus delays the onset of atrophy symptoms.

How safe is laser therapy for atrophic vaginitis? 

Laser therapy can stimulate collagen production and improve blood supply to support regeneration of the vaginal tissue. For some women it could be an effective treatment, but there are not yet enough long-term studies with conclusive results. The decision should therefore always be made together with your gynaecologist.

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