Atrophic Vaginitis

Question 1

How does the vagina change as oestrogen levels fall?

Answer 1

1. Mucosa becomes thinner, less elastic and more dry
2. Tissue more prone to inflammation
3. Vaginal pH changes
4. Microbial flora changes

Question 2

What are symptoms in atrophic vaginitis?

Answer 2

1. Itching
2. Dryness
3. Dyspareunia
4. Bleeding due to localised inflammation
5. Conisder atrophic vaginitis in older women presenting with recurrent UTIs, SUI or POP

Question 3

How will atrophic vaginitis appear on examination?

Answer 3

1. Pale mucosa
2. Thin skin
3. Reduced skin folds
4. Erythema and inflammation
5. Dryness
6. Sparse pubic hair

Question 4

What are examples of vaginal lubricants?

Answer 4

1. Sylk
2. Replens
3. YES

Question 5

What are options for topical oestrogen?

Answer 5

1. Estriol cream, applied using an applicator (syringe) at bedtime
2. Estriol pessaries, inserted at bedtime
3. Estradiol tablets (Vagifem), once daily
4. Estradiol ring (Estring), replaced every three months

Question 6

What are contraindications to topical oestrogen?

Answer 6

1. Breast cancer
2. Angina
3. VTE
4. ? Endometrial hyperplasia and cancer

Question 7

How often should women on topical oestrogen be monitored?

Answer 7

At least annually with a view of stopping treatment whenever possible.