Atrophic Vaginitis (a.k.a: Vaginal Atrophy or Urogenital Atrophy) is the most common condition after menopause. It is the main cause of postmenopausal uterine bleeding. It is also seen in lactating mothers. It is often misconceived as a yeast infection, so seeking medical attention is essential immediately after the onset of symptoms to prevent complications.
What is Atrophic Vaginitis?
Atrophic vaginitis is a chronic inflammatory condition of the vagina. Lower urinary tract can also be inflamed in this condition. In this condition, vaginal walls, especially endothelium, lining of the vagina becomes thin and dry. This condition may occur due to low levels of estrogen, a reproductive hormone.
What Causes Atrophic Vaginitis?
Atrophic vaginitis occurs due to lack of estrogen. Estrogen is the female reproductive hormone and produced by ovaries. It is essential for stimulating the production of mucus to keep the vagina moist (lubrication of the vagina). Decrease in estrogen leads to thinning of vaginal walls and loss of elasticity of vaginal mucosa.
Other causes of atrophic vaginitis are:
- Poor hygiene
- Vaginal infections
- Sexually transmitted diseases (STDs)
- Allergic reactions
- Chronic irritation due to use of tampons or birth control devices
- Douching (spraying with water)
Symptoms of Atrophic Vaginitis:
Atrophic vaginitis is a progressive disease. Symptoms appear gradually and worsen with advancing age. The symptoms are:
- Painful intercourse
- Vaginal soreness, dryness and itching at the vaginal area
- Burning sensation
- Decreased vaginal secretions
- Abnormal vaginal bleeding
- Yellow or green discharge that has bad odor
Symptoms associated with urinary tract are mostly seen during atrophic vaginitis due to thinning of the tissues around the neck of the bladder and urethra. Symptoms that may appear are:
- Urinary urgency
- Frequent urination
- Stress incontinence
Risk Factors of Atrophic Vaginitis:
Menopause is the common risk factor as hormonal fluctuations occur during menopause. Breastfeeding women are also at risk, as prolactin production is high during lactation. Prolactin antagonizes the production of estrogen leading to symptoms of atrophic vaginitis. Other risk factors that are associated with atrophic vaginitis are:
- Previous exposure to radiation therapy or chemotherapy for ovarian ablation
- Immunologic disorders
- Premature ovarian failure
- Endocrine disorders
- Hypothalamic amenorrhea (absence of menstruation for several months due to problems in hypothalamus)
- Hyperprolactinemia (elevated levels of prolactin)
- Use of antiestrogen medications
- History of surgical removal of ovaries (oophorectomy)
- Use of antihistamines and decongestants that cause drying of the mucous membrane
- Chronic diseases such as hypertension and hypercholesteremia
Complications of Atrophic Vaginitis:
Vaginal pH increases during atrophic vaginitis making vagina and urinary tract prone to infections and mechanical weakness. Urinary tract infection is the most common complication of atrophic vaginitis. Other complications associated with it are:
- Cracks in the vaginal wall
- Bleeding after the intercourse
- Increased risk of vaginal infections
Estrogen is also essential for bone health. Due to lack of estrogen hormone, bone density decreases leading to osteoporosis.
If it is left untreated, complications such as losing elasticity in the walls of vagina and frequent vaginal bleeding or spotting can become permanent.
Diagnosis of Atrophic Vaginitis:
The healthcare provider examines the vagina initially to evaluate the signs and symptoms. Following tests are performed to confirm the diagnosis:
Litmus pH Test: Usually pH is high and a pH of ≥ 5 may indicate atrophic vaginitis.
Blood Tests: Serum levels of estrogen ≤ 4.5 are considered low and indicate atrophic vaginitis.
Pap smear Test: A vaginal smear is obtained to examine under the microscope. Presence of parabasal cells, polymorphonuclear leukocytes (PMNs), gram negative flora, and gram positive cocci may indicate atrophic vaginitis.
Ultrasonogram: It is an imaging test performed to detect changes in the vagina. If the endometrial layer thickness is 4 to 5mm, it may indicate atrophic vaginitis.
Treatments for Atrophic Vaginitis:
The treatment for atrophic vaginitis focuses on increasing estrogen levels and providing symptomatic relief.
Estrogen Replacement Therapy: The most effective treatment is providing vaginal estrogen. It can be provided in the following 3 ways:
Vaginal Cream: Local estrogen cream is applied intravaginally every day for the first few weeks followed by every other day.
Vaginal Ring: Estrogen impregnated polymer ring is inserted into the upper part of the vagina. It releases a consistent dose of estrogen. It should be replaced for every 3 months.
Vaginal Tablet: A vaginal tablet is inserted into the vagina daily using a disposable device for first two weeks followed by twice a week thereafter.
Symptomatic Treatment:The healthcare provider may also provide symptomatic treatment if women are ready to undergo estrogen therapy.
Vaginal Lubricants: These can help to improve moisture in the vagina preventing dryness of the vagina.
DHEA Supplements: DHEA (dehydroepiandrosterone) is the precursor of reproductive hormones such as testosterone and estrogen. So, these supplements can help to maintain normal levels of estrogens in the body.
Treatments often have risks accompanied by benefits. So, following certain home remedies may help in speedy recovery:
- Maintain good vaginal hygiene:
- Wash the vagina gently with lukewarm water once a day.
- Change tampons and sanitary pads for every 3 to 4 hours during menstruation.
- Don’t use petroleum jelly for lubrication.
- Don’t rub with a towel after the shower, instead pat it gently with a clean towel.
- Avoid synthetic fabrics and wear breathable cotton underwear as sweat can increase the chances of infections.
- Avoid douching.
- Consuming coconut and olive oils can prevent dryness of the vagina.
- Intake of probiotics such as yoghurt can help to relieve from symptoms.
Prevention of Atrophic Vaginitis:
Regular sexual activity can help to prevent atrophic vaginitis as physical intercourse increases the blood flow to the vagina. Pelvic exercises may also help in improving the blood flow.
Avoid using scented vaginal products such as scented toilet paper and fragrant soaps as these may increase the risk of infections.
Undergo screening tests for gynecological evaluation such as Pap smear regularly from the age of 21. Quit smoking as chemicals in smoke can impair the production of estrogen.