A recent consensus conference agreed that the term “genitourinary syndrome of menopause” is medically more accurate and publicly more acceptable term than “vaginal atrophy”. Presumably the idea behind this decision was to encourage women to talk to their physicians more openly and get appropriate help. It has unfortunately been recognized that this is under-diagnosed and under-treated condition in spite of the fact that effective treatments exist.
Vaginal atrophy or vulvovaginal atrophy is a condition resulting from a lack of oestrogens. The lining of vagina becomes thinner and dryer and about half of postmenopausal women would experience symptoms such as:
- Vaginal dryness, itching and irritation
- Burning feeling in the vagina
- Pain during the intercourse
- Light bleeding after the intercourse
- Burning sensation when urinating
- Frequent and strong urge to urinate
- Urinary incontinence
- Frequent urinary infections
Women are generally reluctant to talk about these problems and somehow hope that they will disappear on their own which is not the case. Unlike hot flushes and sweats which disappear in the majority of menopausal women within five years after the menopause vaginal atrophy is a chronic and progressive condition which with time gets worse, if not treated.
Vaginal atrophy is not only a nuisance but vaginal health is very important for women overall health. There is a misconception that this is only relevant for sexually active women. However, even in those who are not sexually active vaginal atrophy can cause various unpleasant symptoms, vaginal and urinary tract infections and has negative impact on various aspects of their life.
Effective treatments are available but unfortunately under-used because of a lack of appropriate information. If symptoms are mild then any over the counter vaginal lubricant or vaginal moisturizer will help. However gold standard treatment for this condition is local (vaginal) oestrogen. This could be delivered in the form of cream (places into vagina with an applicator), tablet (inserted into vagina with a disposable applicator) or ring (inserted into vagina every three months). Systemic oestrogen therapy is also very effective for GSM symptoms but in the absence of other menopausal symptoms, like hot flushes and sweats, is generally not needed.
In the light of recognized risks associated with long term systemic menopausal hormone therapy it is very important that women understand the difference between systemic oestrogen and local (vaginal) oestrogen therapy. Vaginal oestrogen therapy delivers locally low dose oestrogen which maintains the health of vaginal lining but does not raise oestrogen level in blood above the normal postmenopausal range. Local (vaginal) application of oestrogen is very effective and at the same time safe.