Atrophic vaginitis

Question 1

Define atrophic vaginitis.

Answer 1

Atrophic changes in the vagina due to oestrogen depletion (menopause) and natural ageing.

Question 2

Explain the aetiology/risk factors of atrophic vaginitis.

Answer 2

• Symptoms of urogenital atrophy may occur for first time more than 10 years after LMP
• Vaginal dryness increases with time since menopause
• In premenopausal women, atrophy is rare, but may be due to interference with ovarian
• Production of oestrogen: for example, anti-oestrogen medication or surgery

Question 3

Summarise the epidemiology of atrophic vaginitis.

Answer 3

An estimated 10 to 40 percent of postmenopausal women have symptoms of atrophic vaginitis.

Question 4

Recognise the presenting symptoms of atrophic vaginitis.

Answer 4

Vaginal discomfort and dryness

Dyspareunia

Recurrent lower UTI

Question 5

Recognise the signs of atrophic vaginitis on physical examination.

Answer 5

Speculum:

• Friable epithelium
• Decreased elasticity
• Shiny appearance
• Pale epithelium (diminished capillary blood supply)

Question 6

Identify appropriate investigations for atrophic vaginitis and interpret the results

Answer 6

Speculum exam.

Question 7

Generate a management plan for atrophic vaginitis.

Answer 7

non-HRT: Vaginal lubricant or moisturiser

HRT:
- Offer low dose vaginal oestrogen: May be required long term since symptoms usually reoccur after cessation. Many patients will prefer the silicone ring for easier use than tablets or cream; the
efficacy and safety have been proven to be the same.

• Advise that lubricants or moisturisers can be used in conjunction

Question 8

Identify the possible complications of atrophic vaginitis and its management. Summarise the prognosis for patients with atrophic vaginitis.

Answer 8

No complications, prognosis is not effected.