What Is Vaginal Atrophy?

You recently discussed vaginal dryness — thank you! You mentioned vaginal atrophy, which sounded scary. What is that and how do I prevent it?

—Vag of honor

I agree, vaginal atrophy does sound scary. But it doesn’t have to be if you know what to look for and are proactive. When we progress through the menopausal transition, our estrogen levels drop over time. Estrogen has direct effects on the cells that line the vagina and vulva, and on the muscles that line the vagina.

Low estrogen causes the lining of the vulva and vagina to thin. The muscles below the lining weaken. The cells are also responsible for making vaginal lubricant, and without estrogen, the vagina and vulva become dry. Vaginal dryness is uncomfortable, but it also changes the vaginal flora, which can predispose some women to infections.

Because the muscles lining the vagina are weakened, the vagina and uterus can slump down. This can lead to a number of problems. The uterus can put pressure on the bladder, leading to feelings of urinary frequency. The slumping vagina and uterus bring the urethra and anus in closer proximity, which can increase the risk for urinary tract infections.

Vaginal atrophy can be treated. Both hormone therapy, in the form of patches and pills, and topical estrogen are effective treatments for vaginal atrophy. Most women can safely take vaginal estrogen even if you have a contraindication to taking systemic hormone therapy.

It is possible to avoid vaginal atrophy by proactively treating the first signs of vaginal dryness. If vaginal dryness symptoms are mild, you can try over-the-counter vaginal moisturizers as a first step, but if symptoms are more severe, it is worth making a special visit to your doctor to address them before your annual visit.

The upshot: Vaginal atrophy can be uncomfortable and it can cause health problems, but by proactively treating vaginal dryness, you can avoid vaginal atrophy.