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Vaginal Dryness & Vaginal Atrophy

Vaginal Dryness & Vaginal Atrophy

Vaginal dryness is a common but treatable problem that many women experience at some point in their lives.
Vaginal atrophy is the medical term that refers to the thinning of the wall of the vagina that occurs during menopause.
Vaginal dryness can affect any woman, however after the menopause it is very common, affecting over half of post-menopausal women aged between 51 and 60.
During menopause, estrogen production slows and then stops. When that happens, a number of changes happen in a woman's body.
Periods become irregular and then stop. You may have hot flashes, mood swings, a deeper voice, and an increase in facial hair.

What are the causes of vaginal dryness and vaginal atrophy?
The walls of the vagina stay lubricated with a thin layer of clear fluid. The hormone estrogen helps maintain that fluid and keeps the lining of the vagina healthy, thick, and elastic. During menopause, the drop in estrogen levels reduces the amount of moisture available. It also makes the vagina thinner and less elastic. This is called vaginal atrophy.
In addition to menopause, estrogen levels can drop from:
Childbirth and breastfeeding
Radiation or chemotherapy treatment for cancer
Surgical removal of the ovaries
Anti-estrogen medications used to treat uterine fibroids or endometriosis
Autoimmune disorders
Allergy and cold medications and certain antidepressants
Lack of enough foreplay before sexual intercourse

What are the symptoms of vaginal dryness and vaginal atrophy?
Vaginal symptoms that are commonly associated with vaginal atrophy include vaginal dryness, itching, irritation, and/or pain with sexual intercourse (known as dyspareunia). The vaginal changes also lead to an increased risk of vaginal infections
Periods become irregular and then stop. You may have hot flashes, mood swings, a deeper voice, and an increase in facial hair.
Emotional impact – vaginal dryness can make women feel different. Changes to the body can be difficult to accept and pain and discomfort caused by the condition can lead to a loss in self- confidence and sexual confidence.
Other symptoms may include:
Reduced sex drive
Difficulty getting aroused and reaching orgasm
The surface of the vagina looks pale and thin
Narrowing or shortening of the vagina
Needing to pee more often than usual
Repeated urinary tract infections (UTIs)

How is vaginal dryness and vaginal atrophy diagnosed?
Medical history
Your doctor will likely ask you several questions about your symptoms, some of which may seem unrelated. Make sure to inform your doctor of all prescription and over-the-counter medications you’re taking.

Physical & pelvic exam
Your doctor will also conduct a physical exam, which includes a pelvic exam. During a pelvic exam, your doctor will press down on your abdomen while also inserting a gloved, lubricated finger into your vagina. This will help them detect any changes or abnormalities of the reproductive organs.

Pap smear test
If your doctor is unable to pinpoint a cause for your dryness, or if you have other symptoms, you may need to undergo additional tests. You may need to have a Pap smear, which is when your doctor collects cells from your cervix to test for infection and cancer.

What is treatment for vaginal dryness and vaginal atrophy?
Once your doctor knows the underlying cause of your dryness, you’ll be given treatment options.
Vaginal Lubricants

Hormone therapy
HRT is a treatment that involves taking medication to replace the hormones that start to decline during the menopause.
Most women use one of three types of vaginal estrogen:
Vaginal estrogen ring (Estring). You or your doctor inserts this soft, flexible ring into the vagina. There it releases a steady stream of estrogen directly to the vaginal tissues. The ring is replaced every three months.
Vaginal estrogen tablet (Vagifem). You use a disposable applicator to insert a tablet into your vagina once a day for the first two weeks of treatment. Then you insert it twice a week until you no longer need it.
Vaginal estrogen cream (Estrace, Premarin). You use an applicator to insert the cream into your vagina. You will typically apply the cream daily for one to two weeks then reduce the frequency to one to three times a week as directed by your doctor.

Hormone therapy may not be the right treatment for everyone. Replacing natural estrogen can help with dryness, but can also trigger side effects. These include:
Weight gain
Fluid retention
Breast tenderness
Spotting of the skin
Increased risk of stroke, blood clots, and breast and ovarian cancers.

Alternatives to estrogen therapy
There are several alternatives to estrogen therapy, which work very well and are often worth trying before using estrogen therapy. They include:

Water-based lubricants, which can help add moisture to the vaginal lining. Their effectiveness can last for hours at a time, making them a good alternative when dryness causes discomfort during sexual intercourse.
Vaginal moisturizers made specifically for addressing dryness can be used to relieve symptoms for up to three days with just one application.
Compounds in soybeans and soy products mimic the effects of estrogen. If you add soy to your diet, you may experience some relief from vaginal dryness.
Black cohosh is an herbal supplement that’s considered by some to relieve menopausal symptoms. There are no significant clinical studies that show its effectiveness.
Wild yam is another supplemental ingredient that promises to relieve dryness, but evidence from research is lacking.

What is the outlook for vaginal dryness and vaginal atrophy?

Hormone treatments are available that are very effective in reducing vaginal dryness, but whether or not to use hormone therapy is an individual decision that must consider the inherent risks and benefits of the treatment along with each woman's own medical history. Women with only mild symptoms may experience relief by using vaginal moisturizing agents and/or lubricants during sexual intercourse.

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