Atrophic Vulvo-vaginitis Flashcards
What is atrophic vaginitis?
Dryness and atrophy of vaginal mucosa related to lack of oestrogen
Also known as genitourinary syndrome of the menopause
How does the epithelial lining of the vagina and urinary tract repons to oestrogen?
Thicker
More elastic
Produces secretions
Why is the vagina more prone to inflammation as women enter menopause
Decrease oestrogen means thinner, less elastic and more dry
Changes in vaginal pH and microbial flora - contribute to localised infections
Why does lack of oestrogen increase risk of pelvic organ prolapse and stress incontinence?
Helps maintain healthy connective tissue
How does atrophic vaginitis present?
Itching
Dryness
Dyspareunia
Bleeding - localised inflamamtion
How does atrophic vaginitis present?
Itching
Dryness
Dyspareunia
Bleeding - localised inflamamtion
What women should you consider atrophic vaginitis in?
Recurrent UTI infections, stress incontince, pelvic organ prolapse
What conditions will topical oestrogen improve symptoms
Recurrent UTIs
Stress incontinence
Pelvic prgan prolapse
What questions should you always ask women presenting with potential atrophic vaginitis?
Vaginal dryness
Vaginal discomfort
What would examination of the labia and vagina demonstrate in atrophic vaginitis?
Pale mucosa
Thin skin
Reduced skin folds
Erythema and inflammation
Dryness
Sparse pubic hair
Examples of vaginal lubricants
Sylk, replens, YES
Topical oestrogen options
Estriol cream - applicator at nigth
Estriol pessaries - night
Estradiol tablets - vagifem - once daily
Estradiol ring - estring - replaced every 3 months
What are contraindications for topical oestrogen?
Breast cancer, angina, VTE
When should women be monitored on topical oestrogen?
Annually
View of stopping treatment whenever possible
