Vaginal atrophy: what is it and how can it be treated?

Vaginal atrophy is a common condition for women in the menopause. It is chronic and progressive and will not get better without treatment over time, unlike vasomotor symptoms (Palacios et al, 2020). Vaginal atrophy is a condition in a larger spectrum known as genital syndrome of the menopause (GSM), which incorporates physical changes in the vulva, vagina and lower urinary tract. All of the above structures have oestrogen and androgen receptors and as the oestrogen level decreases several effects are observed as shown in Table 1.

It is estimated that vaginal atrophy affects 50–80% of post-menopausal women and is caused by oestrogen deficiency (Palacios et al, 2020; Davis and Baber, 2022), but it is an under-diagnosed and under-recognised condition. This is due to many factors such as:

Vaginal atrophy and lack of lubrication can also occur at any time in a woman's life and this happens in an estimated 15% of pre-menopausal women, when they are breast feeding, have hypothalamic amenorrhoea, are on the combined oral contraceptive pill, with stress, after chemotherapy and pelvic radiation, and with certain chronic conditions (Edwards and Panay, 2016).