II. Epidemiology
- Prevalence: 50% of post-menopausal women within first 3 years
III. Causes
-
Menopause (most common)
- Vulvovaginal Atrophy and dryness symptomatic in 50% of postmenopausal women (due to low Estrogen)
- Only 25% of symptomatic women seek medical care
- Antiestrogen medications (e.g. Raloxifene, Tamoxifen, GnRH agonists)
- Breast Feeding women
- Central Amenorrhea
IV. Pathophysiology
- Related to decreased Estrogen with Menopause
- Vaginal effects
- Vaginal epithelium thins with decreased lubrication
- Vaginal canal narrowing
- Bleeding or pain on intercourse
- Vulvar mucosa thinning
- Vulvar burning or irritation
- Dyspareunia due to introitus narrowing
- Glycogen loss with altered Vaginal pH and flora
V. Symptoms
- Vaginal Dryness
- Vaginal or vulvar burning, itching or irritation
- Dyspareunia
- Vaginal Discharge
- Urinary urgency
VI. Signs
- Vaginal Discharge that is thin or clear
- Vaginal introitus narrowing
- Loss of labia minora
- Vaginal mucosa changes
- Mucosa is thin, pale and dry with reduced elasticity
- Vaginal rugae lost
- Mucosa may be irritated and friable
VII. Labs
- Vaginal pH 5 to 7
VIII. Complications
IX. Management
- See Menopause
- Symptomatic measures (first-line for mild symptoms)
- Vaginal Moisturizers (Replens) applied three times weekly
- Vaginal Lubricant (e.g. Astroglide) applied before intercourse
- Topical Vaginal Estrogen (second-line for moderate symptoms)
- Does not require systemic Progesterone (in intact Uterus) if used <1 year
- Low dose Topical Estrogen (e.g. Vagifem, Estring, Estrace or Premarin vaginal cream)
- Reduces risk of Recurrent Urinary Tract Infection
- Suckling (2006) Cochrane Database Syst Rev (4): CD001500 [PubMed]
- Intravaginal Prasterone (Intrarosa, synthetic DHEA)
- Vaginal Dehydroepiadrosterone that increases epithelial thickness and decreases Dyspareunia
- Indicated in Dyspareunia and moderate to severe Vulvovaginal Atrophy
- Although marketed as non-Estrogen, it is DHEA which converts to Estrogens and androgens in vaginal tissue
- Expensive (>$200/month)
- Systemic Estrogens (third-line for refractory symptoms)
- Precautions
- Do not use Unopposed Estrogen with intact Uterus (requires concurrent Progesterone)
- Continuous Estrogen Replacement
- Sequential Estrogen Replacement
- Transdermal Estrogen Replacement
- Higher dose Topical Estrogen (e.g. FemRing)
- Requires Progesterone (in intact Uterus), unlike low dose Topical Estrogens
- Precautions
- Other options (refractory symptoms and unable to use Estrogens)
- Osphena (ospemifene)
- Selective Estrogen receptor modifier (SERM) with Vaginal Estrogenic effect (unlike Raloxifene and Tamoxifen)
- FDA-approved for severe Dyspareunia
- Risk of venous thrombosis and Hot Flashes (similar to Raloxifene and Tamoxifen)
- Expensive (> $200/month) with limited indications beyond other measures
- Dose: 60 mg once daily with food
- (2013) Prescr Lett 20(6):33
- Fractional Carbon-Dioxide Laser Therapy
- Results in microabrasions that promote increased Blood Flow and thicken vaginal tissue
- Decreases Dyspareunia
- Similar efficacy to Vaginal Estrogens, but not FDA approved and risk of burns and scarring
- Osphena (ospemifene)
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Related Studies
| Concepts | Disease or Syndrome (T047) |
| ICD9 | 627.3 |
| ICD10 | N95.2 |
| SnomedCT | 156054004, 52441000 |
| English | Postmenopausal atrophic vaginitis, Postmenop atrophic vaginitis, postmenopausal atrophic vaginitis, postmenopausal atrophic vaginitis (diagnosis), Atrophic vaginitis, Senile (atrophic) vaginitis, Vaginitis;senile, atrophic vaginitis, Postmenopausal atrophic vaginitis (disorder), Senile atrophic vaginitis, Senile vaginitis, atrophic; vaginitis, postmenopausal, postmenopausal; atrophic vaginitis, postmenopausal; vaginitis, atrophic, senile; vaginitis, vaginitis; postmenopausal atrophic, vaginitis; senile, senile vaginitis |
| Dutch | postmenopauzale atrofische vaginitis, seniele vaginitis, atrofisch; vaginitis, postmenopauzaal, postmenopauzaal; atrofische vaginitis, postmenopauzaal; vaginitis, atrofisch, seniel; vaginitis, vaginitis; postmenopauzaal atrofisch, vaginitis; seniel, Postmenopauzale atrofische vaginitis |
| French | Vaginite sénile, Vaginite atrophique postménopausique |
| German | senile Vaginitis, postmenopausale atrophische Vaginitis, Atrophische Kolpitis in der Postmenopause |
| Italian | Vaginite senile, Vaginite atrofica postmenopausale |
| Portuguese | Vaginite atrófica pós-menopáusica, Vaginite senil |
| Spanish | Vaginitis atrófica postmenopáusica, Vaginitis senil, vaginitis atrófica posmenopáusica, vaginitis atrófica postmenopáusica, vaginitis atrófica senil (trastorno), vaginitis atrófica senil, vaginitis senil |
| Japanese | 老人性腟炎, 閉経後萎縮性腟炎, ﾛｳｼﾞﾝｾｲﾁﾂｴﾝ, ﾍｲｹｲｺﾞｲｼｭｸｾｲﾁﾂｴﾝ |
| Czech | Postmenopauzální atrofická kolpitis, Stařecká kolpitis |
| Korean | 폐경기후 위축성 질염 |
| Hungarian | postmenopausalis atrophiás vaginitis, senilis vaginitis |
