Oestrogen, the menopause and vaginal atrophy

Women begin producing the female hormone oestrogen from the time they start puberty, and continue to do so until they reach the time of their menopause.

The menopause consists of different phases, from the time of the premenopause or the years leading up to menopause; the menopause itself (also called the perimenopause), which can be defined as one year of no periods; to the time after the menopause, known as the postmenopause. As women live longer, they are likely to spend quite a large part of their lives in a menopausal or postmenopausal state.

During the menopause, production of oestrogen slows down and can lead to a number of different physical changes. One of these changes is known as vaginal atrophy and this can cause symptoms including vaginal discomfort, dryness, itching and burning.

What is vaginal atrophy and why does it happen?

Without the production of oestrogen by the ovaries, the skin and support tissues around the vagina become thin and less elastic than before. This is a normal and common consequence of the menopause, and many women suffer in silence, when they should actually seek medical advice.

What are the symptoms of vaginal atrophy?

Vaginal dryness is often the first reported symptom. This is caused by less mucus being produced by the glands of the vagina.

Thinning of the skin around the vagina and vulva is another symptom. This makes the skin easily damaged, for example during sex, especially if lubrication is poor. It is not unusual that for many women, sex becomes difficult and painful during this time.

Alteration in the normal vaginal discharge is something most women also notice after the menopause. Without oestrogen, the pH (acidity level) of the vaginal secretions changes and this affects the balance of the micro-organisms in the natural secretions. The discharge can lead to vaginal burning and vulval irritation.

How can vaginal atrophy be treated?

There are many ways women can help improve the symptoms of vaginal atrophy, so whatever you do, do not feel you have to put up with it and suffer in silence! Discuss things with your doctor and together you can decide on the best treatment option for you.

You can try over-the-counter vaginal lubricants and moisturisers. These can give you some temporary relief for the dryness and ease the discomfort during intercourse.

You can also use local oestrogen therapy, which is a prescription treatment not available over-the-counter. It is now well recognised that low doses of oestrogen therapy, delivered locally in the vagina, can be effective for treating the symptoms of vaginal atrophy. Vaginal dryness, soreness, burning, vulval irritation and chafing can all respond well to local oestrogen treatments.

Oestrogen delivered locally can be in the form of:

Vaginal tablets: inserted using a pre-loaded applicator. These are used every day for two weeks and then twice weekly, as advised.

Creams: inserted using an applicator, daily at first, then as advised.

Vaginal ring: inserted for a three-month period.

Pessaries: inserted daily (preferably in the evening) at first, then as advised.

These treatments are effective and acceptable and, unlike oral forms of HRT, the effects are local so there is reduced risk of systemic (i.e. whole body) side effects.


This page is intended for UK healthcare professionals only
UK/WB/0416/0011(2)  March 2017

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