Management of postmenopausal vaginal atrophy and atrophic vaginitis

Up to 40 percent of postmenopausal women have symptoms of atrophic vaginitis. The thinned vaginal epithelium and increased vaginal pH level induced by estrogen deficiency predispose the vagina and urinary tract to infection and mechanical weakness. The earliest symptoms are decreased vaginal lubrication, followed by other vaginal and urinary symptoms such as dryness, burning, itching, and dyspareunia that may be exacerbated by superimposed infection. Treatment usually depends on estrogen replacement. Estrogen replacement therapy decreases vaginal pH, thickens and revascularizes the vaginal epithelium, increases the number of superficial cells, and reverses vaginal atrophy and may be provided systemically if symptoms are severe or affect quality of life or locally, but the dosage and delivery method must be individualized. Vaginal moisturizers and lubricants may also be beneficial in the treatment of women with atrophic vaginitis.