Atrophic Vaginitis

Question 1

Definition

Answer 1

Thinning and inflammation of the vaginal mucosa which commonly affects postmenopausal women

Question 2

Epidemiology and risk factors

Answer 2

• Menopause
• Oophorectomy
• Anti-oestrogen medication: tamoxifen, aromatase inhibitors
• Radiotherapy
• Chemotherapy
• Postpartum +/- breastfeeding

Question 3

Pathophysiology

Answer 3

Oestrogen helps maintain the vaginal epithelial thickness by producing glycogen which acts as a source of nutritional for lactic acid forming bacteria. The production of this lactic acid maintains the acidic environment in the vagina.
Once oestrogen levels fall following menopause = vaginal mucosa becomes thin and becomes drier.

Question 4

Signs

Answer 4

• Narrow inhibtors
• Reduced pubic hair
• Reduced vulval skin turgor or elasticity
• Thin vaginal mucosa with erythema
• Dry vaginal skin mucosa
• Prolapse: rare

Question 5

Symptoms

Answer 5

• Vaginal dryness: most common symptoms
• Vulval/vaginal ithcing or burning
• Dyspareunia (painful sex)
• Post-coital bleeding
• Vaginal discharge: white or yellow
• Decreased arousal

Question 6

Diagnosis

Answer 6

Clinical diagnosis
Consider:
- Vaginal pH testing: more alkaline in AV
- Vagina; cytology: lack of maturation of vaginal epithelium

Question 7

Treatment

Answer 7

• Oestrogen therapy:
  = local oestrogen replacement: estradiol vaginal ring
  = systemic hormone replacement therapy
• Non-hormonal based treatments:
  = vaginal lubricants
  = vaginal moisturisers
  = laser therapy
  = ospemifene: selective oestrogen receptor modulator for dyspareneuria and dryness

Question 8

Complications

Answer 8

Dyspareunia
UTI
Urethral and vaginal prolapse
Systemic HRT complications: increased breast and endometrial cancer risk