What are the treatment options for vaginal atrophy?

Patient Handout: Understanding and Managing Vaginal Atrophy

What is Vaginal Atrophy?

Vaginal atrophy is a common condition that occurs when vaginal tissues become thin, dry, and inflamed due to decreased estrogen levels, most commonly during menopause. This condition affects approximately one-third of postmenopausal women and can significantly impact quality of life 1, 2.

Common Symptoms

• Vaginal dryness 1, 2
• Itching and burning sensation 1, 2
• Discomfort or pain during sexual intercourse (dyspareunia) 1, 2
• Vaginal discharge 1
• Urinary symptoms (frequency, urgency, recurrent infections) 3
• Decreased lubrication during sexual activity 1, 4

Treatment Options

Non-Hormonal Options

• Vaginal moisturizers and lubricants

  • Regular use of over-the-counter vaginal moisturizers can provide relief from dryness and discomfort 1, 3
  • Water-based lubricants are recommended for use during sexual activity 1
  • Silicone-based products may last longer than water-based or glycerin-based products 1

• Regular sexual activity

  • Helps maintain vaginal health and blood flow 3
  • May help prevent worsening of symptoms 1

• Vaginal dilators

  • Can help with pain during sexual activity and increase vaginal accommodation 1
  • Particularly useful for women with vaginal stenosis (narrowing) 1

• Pelvic floor physical therapy

  • Can improve sexual pain, arousal, lubrication, and satisfaction 1
  • Particularly helpful for women who also have pelvic floor dysfunction 1

Prescription Options

• Vaginal estrogen therapy

  • Most effective treatment for vaginal dryness and associated symptoms 1, 5
  • Available in several forms:
    • Vaginal creams 1, 6
    • Vaginal tablets 1, 5
    • Vaginal rings (sustained-release) 1, 3
  • Low-dose formulations minimize systemic absorption 1, 5
  • A large study showed no increased risk of breast cancer recurrence with vaginal estrogen use 1

• DHEA (prasterone)

  • FDA-approved for vaginal dryness and pain with sexual activity 1
  • Improves sexual desire, arousal, pain, and overall sexual function 1
  • Should be used with caution in women on aromatase inhibitor therapy 1

• Ospemifene

  • FDA-approved oral medication for moderate to severe dyspareunia and vaginal dryness 7
  • Effective for treating vulvar and vaginal atrophy 1, 7
  • Not recommended for women with a history of estrogen-dependent cancers 7
  • Should be taken with food once daily 7

• Other medications for sexual desire issues

  • Flibanserin - for hypoactive sexual desire disorder in premenopausal women 1
  • Bremelanotide - for low sexual desire in premenopausal women 1
  • Bupropion or buspirone - may help with low desire or libido 1

Special Considerations

• For breast cancer survivors:

  • Non-hormonal options should be tried first 1
  • If vaginal estrogen is needed, discuss risks and benefits with your healthcare provider 1
  • Estriol-containing preparations may be preferable for women on aromatase inhibitors 1

• For women with recurrent urinary tract infections:

  • Vaginal estrogen therapy may help reduce frequency of infections 3
  • Cranberry juice (pure, not cocktail) may help decrease risk 3

When to See Your Healthcare Provider

• If symptoms persist despite over-the-counter treatments
• If you experience pain during intercourse that doesn't improve with lubricants
• If you notice any unusual vaginal bleeding
• If you have concerns about using hormonal treatments, especially with a history of certain cancers

Remember: Vaginal atrophy is a treatable condition. Don't hesitate to discuss your symptoms with your healthcare provider to find the most appropriate treatment for you.