This condition has a number of names: atrophy, vulvar atrophy, urogenital atrophy and others not listed here. The symptoms include vulvar irritation, itching, burning, odorous yellowish discharge, pain with intercourse, spotting after intercourse and dryness. Other notable effects include urinary frequency and urgency. It is easy to see how this condition could be confused with urinary tract infection, candidiasis, bacterial infection, trichomoniasis or some other sexually transmitted infection.
The decrease in estrogen levels that occur after menopause causes the genital tissue to become thin, dry and inflamed. Estrogen acts on the lower genital tract, including the urethra and bladder making the tissue thick, resilient and moist. A normal birth canal has a plush, pink rugated appearance with a moist surface. An atrophic one looks dramatically different. It is thin, red or pale, lack rugae, dry or has yellowish discharge. Petechiae may be seen, the cervix may appear flushed with the walls and the canal itself maybe unusually narrow or short.
Estrogen acts in a number of ways to sustain a healthy genital tract. It maintains collagen content so the tissue is elastic and distensible. It maintains certain chemical components within the cells which keep the surface lubricated. Finally it helps maintain normal genital blood flow. The cells have large glycogen content and when they shed this glycogen is converted to lactic acid by the lactobacilli that are a part of the normal genital tract ecosystem. This creates an acidic environment that is resistant to infection.
Once a woman’s ovaries stop working, the estrogen level drops by 95% and the lower genital tract is affected. Other conditions that create a low estrogen state can also lead to these problems. This includes medications that cause a medical menopause, medications that block estrogen receptors such as those use to treat breast cancer, or if the ovaries are surgically removed.
Up to 40% of postmenopausal women suffer from these problems but most do not complain to their doctors. Many believe it is a normal part of aging and there isn’t anything that can be done. Discussing these symptoms with your gynecologist is a good idea. There may be an infection that needs to be treated or you may find the solution is simpler than expected. The goal of treatment is to relieve the bothersome symptoms.
Some women find the use of lubricants during intercourse helpful. Other may find resolution using local moisturizers. Two examples of moisturizers are Replens and Lubrin. These are available over the counter and are simple to use. If this isn’t helpful then local treatment with estrogen creams, tablets or rings are an option. Local estrogen treats the genital tissue directly with only low levels of estrogen reaching the blood stream.
Some women, such as those who have had breast cancer or those who have a clotting tendency, should not use estrogen in any form. Recent studies have shown some relief with the use of pH balanced gels. They act directly on the tissue of the birth canal to lower the pH leading to a 50% improvement in dryness and pain with intercourse. Currently available brands are RepHresh (USA) and Balance Activ gel (UK).
Menopause is the beginning of a new you and there is no reason to tolerate annoying symptoms that decreases the quality of your life. Urogenital atrophy can be quite bothersome but low risk treatments are available. Please don’t hesitate to discuss your concerns with your gynecologist. She can help you select the treatment that is right for you.
I hope this article has provided you with information that will help you make wise choices, so you may:
Live healthy, live well and live long!
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