Atrophic vaginitis

Question 1

Define atrophic vaginitis.

Answer 1

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

Question 2

Give 4 causes of atrophic vaginitis.

Answer 2

Natural menopause or oophorectomy.

Anti-oestrogenic Tx - eg, tamoxifen, aromatase inhibitors.

Radiotherapy or chemotherapy.

Postpartum/ breast-feeding, due to reduced oestrogen levels.

Question 3

Give 5 symptoms of atrophic vaginitis

Answer 3

Vaginal dryness +/- itching

Dyspareunia

Discharge: white/ yellow

PV bleeding/ PCB

Recurrent lower UTI

Question 4

Give 4 signs of atrophic vaginitis on speculum examination

Answer 4

Pale, thin vaginal walls
Loss of rugal folds
Friable epithelium: Cracks or fissures
Petechiae

Question 5

Identify appropriate investigations for atrophic vaginitis and interpret the results

Answer 5

1. Clinical examination
2. Swabs for potential infection
3. Biopsy for potential malignancy/ ulcers

Question 6

What non hormonal treatment is available for atrophic vaginitis?

Answer 6

Vaginal lubricant
Vaginal moisturiser

Question 7

What hormonal treatment is available for atrophic vaginitis?

Answer 7

Low dose oestrogen: Topical rings, creams, tablets

May be required long term since Sx usually reoccur after cessation.

Lubricants or moisturisers can be used in conjunction

Question 8

What are the most efficacious treatments for atrophic vaginitis?

Answer 8

Topical + systemic oestrogens

Question 9

Which type of HRT is first line for symptoms of atrophic vaginitis but no other menopausal symptoms?

Answer 9

Topical

(Systemic if menopausal Sx, but may require topical too)