As a part of the female reproductive system, the vagina plays a role in childbirth, menstruation and sexual activity. Throughout a woman’s life, the vagina undergoes changes in response to the level of circulating oestrogen. Ostrogen is a hormone produced by ovaries, which among numerous functions is responsible for the structure and function of the vaginal wall, for the elasticity of tissues around the vagina and for the production of the vaginal fluid. The fluid moistens and lubricates vaginal walls, and due to its acidity protects the vagina from infections.

Vaginal atrophy

Menopause is a leading cause of decreased level of circulating oestrogen. In nonmenopausal women production of oestrogen can be interrupted by radiation therapy, chemotherapy, immunologic disorders or some medications.

As the vagina is sensitive to oestrogens, a number of physiological changes occur upon prolonged decrease in the hormone level: the vagina shortens and becomes less elastic, its wall become thinner, and lubricating secretion diminishes. Oestrogen deficiency also leads to a decrease in acidity of vaginal fluid thereby predisposing the vagina to infections. All these changes commonly lead to the emergence of symptoms of vaginal atrophy, which include vaginal dryness, burning, itching, soreness, painful intercourse, bleeding or spotting during and after intercourse. Thus vaginal atrophy may adversely affect women’s quality of life.

Treatment options

Although up to 40% of postmenopausal women experience atrophic vaginitis,6 only 25% of them seek medical assistance.7 Only a few women receive therapy for vaginal symptoms because of a combination of embarrassment, underdiagnosis and greater attention given to other diseases.8 While menopause is a natural part of women’s life, the vaginal atrophy associated with it could be successfully treated. Although women may feel uncomfortable to talk about their vaginal discomfort, it is very important to overcome communication barriers and discuss this issue openly with doctors.

Effective treatment options for vaginal atrophy are available, and they typically consist of local oestrogen administration. There are different forms of topical oestrogens to be applied in the vagina: creams, ring, vagitories and vaginal tablet. Creams are inserted in the vagina via applicators, but leakage of medication cannot be excluded and sanitary protection may be needed.9

Oestrogen-releasing vaginal ring is inserted by doctor and needs to be replaced after 3 months. Vagitories are inserted in the vagina where they dissolve; however the leakage of medication from the vagina is observed in many women.9 The vaginal tablet is specially designed to provide a slow release of oestrogen and is inserted in the vagina with a preloaded applicator.

In a clinical study the use of vaginal tablets was better rated than vaginal creams in terms of ease and comfort of administration as well as overall acceptance by women suffering from atrophic vaginits.8 Thus the vaginal oestrogen tablet provides a clean, hygienic treatment option.9 A reassessment of your therapy in dialogue with your doctor is recommended.

Why not break the silence and talk with doctors?

Here are some recommendations on how to deal with vaginal atrophy:

  • If you experience any vaginal discomfort please contact your doctor for further examination and treatment
  • It is useful to provide your doctor with daily records of vaginal symptoms
  • Bring up sexual problems in discussion with your doctor. Many sexual concerns can be successfully resolved thus improving your quality of life
  • Inform your doctor about all medications you are taking as some of them can dry the vagina and cause symptoms that may mimic vaginal atrophy
  • Ask your doctor about different treatment options for vaginal atrophy such as oestrogen creams, ring, vagitories and vaginal tablet
  • Discuss openly with your doctor all possible concerns you may have regarding the condition itself or available treatments
  • You may also involve your partner in discussion with your doctor

Successful treatment for vaginal atrophy is available – why not ask for it?

APROM ID# 3079. May 2011.