Vaginal atrophy - Diagnosis and treatment (2023)

Diagnosis

Pelvic exam

Vaginal atrophy - Diagnosis and treatment (1)

Pelvic exam

In a pelvic exam, your health care provider inserts two gloved fingers inside your vagina. Pressing down on your abdomen at the same time, your provider can examine your uterus, ovaries and other organs.

(Video) Vaginal Atrophy, Causes, Signs and Symptoms, Diagnosis and Treatment.

Diagnosis of genitourinary syndrome of menopause (GSM) may involve:

  • Pelvic exam, during which your doctor feels your pelvic organs and visually examines your external genitalia, vagina and cervix.
  • Urine test, which involves collecting and testing your urine, if you have urinary symptoms.
  • Acid balance test, which involves taking a sample of vaginal fluids or placing a paper indicator strip in your vagina to test its acid balance.

More Information

  • Pap smear
  • Pelvic exam
  • Urinalysis

Treatment

To treat genitourinary syndrome of menopause, your doctor may first recommend over-the-counter treatment options, including:

  • Vaginal moisturizers. Try a vaginal moisturizer (K-Y Liquibeads, Replens, Sliquid, others) to restore some moisture to your vaginal area. You may have to apply the moisturizer every few days. The effects of a moisturizer generally last a bit longer than those of a lubricant.
  • Water-based lubricants. These lubricants (Astroglide, K-Y Jelly, Sliquid, others) are applied just before sexual activity and can reduce discomfort during intercourse. Choose products that don't contain glycerin or warming properties because women who are sensitive to these substances may experience irritation. Avoid petroleum jelly or other petroleum-based products for lubrication if you're also using condoms, because petroleum can break down latex condoms on contact.

If those options don't ease your symptoms, your doctor may recommend:

Topical estrogen

Vaginal estrogen has the advantage of being effective at lower doses and limiting your overall exposure to estrogen because less reaches your bloodstream. It may also provide better direct relief of symptoms than oral estrogen does.

Vaginal estrogen therapy comes in a number of forms. Because they all seem to work equally well, you and your doctor can decide which one is best for you.

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  • Vaginal estrogen cream (Estrace, Premarin). You insert this cream directly into your vagina with an applicator, usually at bedtime. Typically women use it daily for one to three weeks and then one to three times a week thereafter, but your doctor will let you know how much cream to use and how often to insert it.
  • Vaginal estrogen suppositories (Imvexxy). These low-dose estrogen suppositories are inserted about 2 inches into the vaginal canal daily for weeks. Then, the suppositories only need to be inserted twice a week.
  • Vaginal estrogen ring (Estring, Femring). You or your doctor inserts a soft, flexible ring into the upper part of the vagina. The ring releases a consistent dose of estrogen while in place and needs to be replaced about every three months. Many women like the convenience this offers. A different, higher dose ring is considered a systemic rather than topical treatment.
  • Vaginal estrogen tablet (Vagifem). You use a disposable applicator to place a vaginal estrogen tablet in your vagina. Your doctor will let you know how often to insert the tablet. You might, for instance, use it daily for the first two weeks and then twice a week thereafter.

Ospemifene (Osphena)

Taken daily, this pill can help relieve painful sex symptoms in women with moderate to severe GSM. It is not approved in women who've had breast cancer or who have a high risk of developing breast cancer.

Prasterone (Intrarosa)

These vaginal inserts deliver the hormone DHEA directly to the vagina to help ease painful sex. DHEA is a hormone that helps the body produce other hormones, including estrogen. Prasterone is used nightly for moderate to severe vaginal atrophy.

Systemic estrogen therapy

If vaginal dryness is associated with other symptoms of menopause, such as moderate or severe hot flashes, your doctor may suggest estrogen pills, patches or gel, or a higher dose estrogen ring. Estrogen taken by mouth enters your entire system. Ask your doctor to explain the risks versus the benefits of oral estrogen, and whether or not you would also need to take another hormone called progestin along with estrogen.

Vaginal dilators

You may use vaginal dilators as a nonhormonal treatment option. Vaginal dilators may also be used in addition to estrogen therapy. These devices stimulate and stretch the vaginal muscles to reverse narrowing of the vagina.

If painful sex is a concern, vaginal dilators may relieve vaginal discomfort by stretching the vagina. They are available without a prescription, but if your symptoms are severe, your doctor may recommend pelvic floor physical therapy and vaginal dilators. Your health care provider or a pelvic physical therapist can teach you how to use vaginal dilators.

Topical lidocaine

Available as a prescription ointment or gel, topical lidocaine can be used to lessen discomfort associated with sexual activity. Apply it five to 10 minutes before you begin sexual activity.

If you've had breast cancer

If you have a history of breast cancer, tell your doctor and consider these options:

(Video) Vaginal atrophy/Causes, symptoms and treatments. How to end the misery. (Atrophic vaginitis)

  • Nonhormonal treatments. Try moisturizers and lubricants as a first choice.
  • Vaginal dilators. Vaginal dilators are a nonhormonal option that can stimulate and stretch the vaginal muscles. This helps to reverse narrowing of the vagina.
  • Vaginal estrogen. In consultation with your cancer specialist (oncologist), your doctor might recommend low-dose vaginal estrogen if nonhormonal treatments don't help your symptoms. However, there's some concern that vaginal estrogen might increase your risk of the cancer coming back, especially if your breast cancer was hormonally sensitive.
  • Systemic estrogen therapy. Systemic estrogen treatment generally isn't recommended, especially if your breast cancer was hormonally sensitive.

Request an Appointment at Mayo Clinic

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

If you're experiencing vaginal dryness or irritation, you may find relief if you:

  • Try an over-the-counter moisturizer. Examples include K-Y Liquibeads, Replens and Sliquid. This can restore some moisture to your vaginal area.
  • Use an over-the-counter water-based lubricant. A lubricant can reduce discomfort during intercourse. Examples include Astroglide, K-Y Jelly and Sliquid.
  • Allow time to become aroused during intercourse. The vaginal lubrication that results from sexual arousal can help reduce symptoms of dryness or burning.

Alternative medicine

Some alternative medicines are used to treat vaginal dryness and irritation associated with menopause, but few approaches are backed by sufficient evidence from clinical trials. Interest in complementary and alternative medicine is growing, and researchers are working to determine the benefits and risks of various alternative treatments for genitourinary syndrome of menopause.

Talk with your doctor before taking any herbal or dietary supplements for perimenopausal or menopausal symptoms. The Food and Drug Administration doesn't regulate herbal products, and some may interact with other medications you take, putting your health at risk.

Preparing for your appointment

You'll probably start by discussing your symptoms with your primary care provider. If you aren't already seeing a doctor who specializes in women's health (gynecologist or internal medicine women's health specialist), your primary care provider may refer you to one.

(Video) Vaginal atrophy solved! MonaLisa and Thermiva

What you can do

To prepare for your appointment:

  • Make a list of any signs and symptoms you're experiencing. Include those that may seem unrelated to the reason for your appointment.
  • Make a note of key personal information. Include any major stresses or recent life changes.
  • Make a list of all medications that you take. Include prescription and nonprescription drugs, vitamins and supplements and note the doses.
  • Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who goes with you may remember something that you missed or forgot.
  • Prepare questions. Make the most of your time with your doctor by preparing a list of questions before your appointment.

Some basic questions to ask include:

  • What's the most likely cause of my symptoms?
  • Are there other possible causes?
  • What kinds of tests do I need?
  • Is my condition likely temporary or long lasting?
  • What treatment options are available? What do you recommend for me?
  • What are the alternatives to the primary approach that you're suggesting?
  • I have some other health conditions. How can I best manage these conditions together?
  • Should I see a specialist?
  • Are there brochures or other printed materials that I can have? What websites do you recommend?

What to expect from your doctor

Your doctor will ask questions about your symptoms and assess your hormonal status. Questions your doctor may ask include:

  • What vaginal or urinary symptoms have you noticed?
  • How long have you had these symptoms?
  • Are you still having menstrual periods?
  • How much distress do your symptoms cause you?
  • Are you sexually active?
  • Do your symptoms limit your sexual activity?
  • Have you been treated for cancer?
  • Do you use scented soap or bubble bath?
  • Do you douche or use feminine hygiene spray?
  • What medications, vitamins or other supplements do you take?
  • Have you tried any over-the-counter moisturizers or lubricants?

Sept. 17, 2021

FAQs

How vaginal atrophy is diagnosed? ›

The healthcare provider can diagnose vaginal atrophy based on your symptoms and a pelvic exam to look at how the vagina appears. It will help to know whether or not you are in menopause. Classic signs of atrophy during a pelvic exam include: A shortened or narrowed vagina.

What do doctors prescribe for vaginal atrophy? ›

There are several treatment options for vaginal dryness. Some, such as vaginal moisturizers or lubricants, are available without a prescription. Others require a prescription; these include a vaginal estrogen cream, tablet, capsule, or ring; an oral medication called ospemifene; and a vaginal tablet called prasterone.

What does vaginal atrophy look like? ›

Vulvar and vaginal mucosae may appear pale, shiny, and dry; if there is inflammation, they may appear reddened or pale with petechiae. Vaginal rugae disappear, and the cervix may become flush with the vaginal wall. Vaginal shortening and narrowing tend to occur. A thin watery yellow vaginal discharge may be observed.

Can a doctor see vaginal atrophy? ›

Finally, your doctor will likely perform a vaginal exam. They'll need to see the appearance of your vaginal tissue, Dr. Park says. “When we look at the tissues, we can see if they've started to atrophy,” Dr.

How can I increase my estrogen level? ›

How can I increase my estrogen levels naturally?
  1. Soy products – Soy products are well known for their high concentrations of phytoestrogens. ...
  2. Legumes – Legumes are another source of phytoestrogens. ...
  3. Nuts and seeds – Nuts and seeds can also be a source of phytoestrogens.
17 Aug 2022

What are the symptoms of low estrogen? ›

Signs of low estrogen include:
  • Dry skin.
  • Tender breasts.
  • Weak or brittle bones.
  • Trouble concentrating.
  • Moodiness and irritability.
  • Vaginal dryness or atrophy.
  • Hot flashes and night sweats.
  • Irregular periods or no periods (amenorrhea).
8 Feb 2022

Can vulvar atrophy be reversed? ›

With treatment, you can see real changes—but it might not be the 100% reversal you're looking for. “With local estrogen products, we do see a change in the skin, and we see improvement with physical therapy and dilators—so we do see reversal of the physical changes with treatment,” explains Dr.

Can a gynecologist help with vaginal atrophy? ›

Treatment for vaginal atrophy

When you need something more, your OBGYN might prescribe estrogen therapy. Estrogen therapy comes in many forms. Topically, they include vaginal estrogen cream, a vaginal estrogen ring, and vaginal estrogen tablets.

Who should I see for vaginal atrophy? ›

Your primary care physician (PCP) may be able to help you find a solution for vaginal dryness, but it's more likely that you will see a gynecologist. A gynecologist specializes in the female reproductive system.

Can urologist treat vaginal atrophy? ›

Some urology centers may offer advanced technology to treat vaginal atrophy, such as the MonaLisa Touch laser therapy system. Many women undergoing laser therapy enjoy significant improvements in their symptoms in just three short sessions.

Does vitamin D increase estrogen? ›

High blood levels of vitamin D linked to reduced estrogen – and potentially lower breast cancer risk. Can taking daily vitamin D supplements decrease sex-hormone levels and thereby potentially reduce the risk of breast cancer in older women?

What vitamins help increase estrogen? ›

B vitamins

B vitamins play an important role in the creation and activation of estrogen in the body. Low levels of these vitamins can lead to reduced levels of estrogen.

What is a good substitute for estrogen? ›

Plant-derived estrogens (phytoestrogens) — Plant-derived estrogens have been marketed as a "natural" or "safer" alternative to hormones for relieving menopausal symptoms. Phytoestrogens are found in many foods, including soybeans, chickpeas, lentils, flaxseed, lentils, grains, fruits, vegetables, and red clover.

What does vaginal dryness feel like? ›

Symptoms of vaginal dryness

feel sore or itchy in and around your vagina. feel pain or discomfort during sex. need to pee more often than usual. keep getting urinary tract infections (UTIs)

What causes vaginal dryness? ›

Reduced estrogen levels are the main cause of vaginal dryness. Estrogen is a hormone that helps keep vaginal tissue healthy by maintaining normal vaginal lubrication, tissue elasticity and acidity. Other causes of vaginal dryness include certain medical conditions or hygiene practices.

Are eggs high in estrogen? ›

Products like eggs or milk contain high estrogen levels because they are produced in parts of the animal's body that regulate its hormones. Eating high estrogen foods can help people who suffer from various conditions related to low estrogen levels.

What foods are high in estrogen? ›

What foods cause high estrogen?
  • Phytoestrogens. Phytoestrogens refer to estrogens that occur in foods. ...
  • Lignans. Lignans are a type of phytoestrogen found in grains, nuts, seeds, plants, wine, and tea. ...
  • Flaxseed. ...
  • Soybean products. ...
  • Chocolate. ...
  • Fruits and vegetables. ...
  • Chickpeas. ...
  • Legumes.
5 Nov 2021

What is vaginal atrophy? ›

Vaginal atrophy (atrophic vaginitis) is thinning, drying and inflammation of the vaginal walls that may occur when your body has less estrogen. Vaginal atrophy occurs most often after menopause. For many women, vaginal atrophy not only makes intercourse painful but also leads to distressing urinary symptoms.

What happens when you have no estrogen? ›

Estrogen affects the hypothalamus, which regulates body temperature. Low estrogen causes hot flashes and night sweats, two annoying symptoms of menopause and perimenopause.

How is muscle atrophy diagnosed? ›

How is muscle atrophy diagnosed?
  1. Blood test.
  2. Muscle or nerve biopsy.
  3. Electromyography (EMG).
  4. Nerve conduction studies.
  5. X-rays.
  6. Computed tomography (CT) scan.
  7. Magnetic resonance imaging (MRI) scan.
21 Jan 2022

Can you reverse vaginal atrophy? ›

Currently, estrogen replacement is the best way to reverse vaginal atrophy and GSM. Not every woman will be able to use this treatment option, however. Concerns about the long-term effects of increased estrogen sometimes discourage doctors from prescribing it.

What causes vaginal atrophy? ›

The cause of vaginal atrophy is a drop in estrogen levels. At menopause, a woman's estrogen levels can fall by about 85%. When your body has less estrogen, your genital tissues become more fragile.

What are the symptoms of low estrogen? ›

Signs of low estrogen include:
  • Dry skin.
  • Tender breasts.
  • Weak or brittle bones.
  • Trouble concentrating.
  • Moodiness and irritability.
  • Vaginal dryness or atrophy.
  • Hot flashes and night sweats.
  • Irregular periods or no periods (amenorrhea).
8 Feb 2022

What are 4 potential causes of atrophy? ›

Other causes of muscle atrophy may include:
  • Burns.
  • Long-term corticosteroid therapy.
  • Malnutrition.
  • Muscular dystrophy and other diseases of the muscle.
  • Osteoarthritis.
  • Rheumatoid arthritis.
9 Nov 2021

What does atrophy feel like? ›

Muscle atrophy symptoms include balance problems, loss of muscle coordination, facial weakness, tingling sensation in arms and legs, vision problems, fatigue, and more. In some cases, individuals with this condition also experience difficulty speaking and swallowing.

What are the two types of atrophy? ›

There are two types of muscle atrophy: disuse and neurogenic.

How can I increase my estrogen level? ›

How can I increase my estrogen levels naturally?
  1. Soy products – Soy products are well known for their high concentrations of phytoestrogens. ...
  2. Legumes – Legumes are another source of phytoestrogens. ...
  3. Nuts and seeds – Nuts and seeds can also be a source of phytoestrogens.
17 Aug 2022

How does vaginal atrophy affect bladder? ›

Vaginal atrophy, which may affect up to 45% of postmenopausal women, is often associated with one or more urinary symptoms, including urgency, increased frequency, nocturia, dysuria, incontinence, and recurrent urinary tract infection.

What does estrogen cream do for a woman? ›

Using or applying an estrogen relieves or lessens: Dryness and soreness in the vagina. Itching, redness, or soreness of the vulva. Feeling an urge to urinate more often then is needed or experiencing pain while urinating.

How long does it take for estradiol cream to work? ›

It can take up to 4 months to see the full effect of the estrogens. Your doctor may reconsider continuing your estrogen treatment or may lower your dose several times within the first one or two months, and every 3 to 6 months after that.

Does vitamin D increase estrogen? ›

High blood levels of vitamin D linked to reduced estrogen – and potentially lower breast cancer risk. Can taking daily vitamin D supplements decrease sex-hormone levels and thereby potentially reduce the risk of breast cancer in older women?

What vitamins can increase estrogen? ›

B vitamins

B vitamins play an important role in the creation and activation of estrogen in the body. Low levels of these vitamins can lead to reduced levels of estrogen.

What foods are high in estrogen? ›

What foods cause high estrogen?
  • Phytoestrogens. Phytoestrogens refer to estrogens that occur in foods. ...
  • Lignans. Lignans are a type of phytoestrogen found in grains, nuts, seeds, plants, wine, and tea. ...
  • Flaxseed. ...
  • Soybean products. ...
  • Chocolate. ...
  • Fruits and vegetables. ...
  • Chickpeas. ...
  • Legumes.
5 Nov 2021

Videos

1. How I cope with Vaginal Atrophy - Jane Lewis, author of 'Me & My Menopausal Vagina'
(The Latte Lounge)
2. Vaginal Atrophy Symptoms
(For Your Life)
3. What Is Vaginal Atrophy?
(Specialist Clinics of Australia)
4. What is Vaginal Atrophy, and What are the Symptoms?
(Columbia University Medical Center Department of OB/GYN)
5. Vaginal Atrophy with Dr. Cleve Ziegler
(Hôpital général juif / Jewish General Hospital)
6. Atrophic Vaginitis
(Danvers Nursing Institute)
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