Skip to main content
SpringerLink
Log in

Atrophic Vaginitis in the Menopause

  • Chapter
  • First Online:
Skin, Mucosa and Menopause

  • 1383 Accesses

Abstract

Vulvovaginal atrophy and atrophic vaginitis are extremely common variants of lower genital tract states of estrogen deficiency affecting women of all socioepidemiologic strata worldwide. Recent molecular studies have emerged linking vaginal microbiota to vulvovaginal atrophy. Unfortunately these clinical conditions are under-recognized, underappreciated, and untreated, resulting in unnecessary suffering. Clinical manifestations are highly variable and are described here together with differential diagnosis, laboratory diagnosis, and treatment modalities. Multiple therapeutic options are now available although regrettably often unaffordable. Treatments are described together with local and systemic adverse effects and complications with particular reference to symptomatic postmenopausal women with estrogen receptor-positive breast cancer. Additional safer, inexpensive treatment regimens are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. MacBride MB, Rhodes DJ, Shuster LT. Vulvovaginal atrophy. Mayo Clin Proc. 2010;85:87–94.

    Article  Google Scholar 

  2. Santoro N, Komi J. Prevalence and impact of vaginal symptoms among postmenopausal women. J Sex Med. 2009;6:2133–42.

    Article  PubMed  Google Scholar 

  3. Bachmann GA, Nevadunsky NS. Diagnosis and treatment of atrophic vaginitis. Am Fam Physician. 2000;61:3090–6.

    CAS  PubMed  Google Scholar 

  4. Wills S, Ravipati A, Venuturumilli P, Kresge C, Folkerd E, Dowsett M, et al. Effects of vaginal estrogens on serum estradiol levels in postmenopausal breast cancer survivors and women at risk of breast cancer taking an aromatase inhibitor or a selective estrogen receptor modulator. J Oncol Pract. 2012;8:144–8.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Farage MA, Sobel JD. Vaginal flora in the menopause. In: Farage MA, Miller KW, Maibach HL, editors. Textbook of the aging skin. Heidelberg: Springer; 2010.

    Chapter  Google Scholar 

  6. Brotman RM, Shardell MD, Gajer P, Fadrosh D, Chang K, Silver MI, et al. Association between the vaginal microbiota, menopause status, and signs of vulvovaginal atrophy. Menopause. 2014;21:450–8.

    Google Scholar 

  7. North American Menopause Society. The role of local vaginal estrogen for treatment of vaginal atrophy in postmenopausal women: position statement of The North American Menopause Society. Menopause. 2007;14(3 Pt 1):355–69.

    Google Scholar 

  8. Dennerstein L, Dudley EC, Hopper JL, Guthrie JR, Burger HG. A prospective population-based study of menopausal symptoms. Obstet Gynecol. 2000;96:351–8.

    Article  CAS  PubMed  Google Scholar 

  9. Ginocchio CC, Chapin K, Smith JS, Aslanzadeh J, Snook J, Hill CS, et al. Prevalence of Trichomonas vaginalis and coinfection with Chlamydia trachomatis and Neisseria gonorrhoeae in the United States as determined by the Aptima Trichomonas vaginalis nucleic acid amplification assay. J Clin Microbiol. 2012;50:2601–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Sobel JD, Reichman O, Misra D, Yoo W. Prognosis and treatment of desquamative inflammatory vaginitis. Obstet Gynecol. 2011;117:850–5.

    Article  PubMed  Google Scholar 

  11. Goodman MP. Are all estrogens created equal? A review of oral vs. transdermal therapy. J Womens Health (Larchmt). 2012;21:161–9.

    Article  Google Scholar 

  12. Bachmann G, Bouchard C, Hoppe D, Ranganath R, Altomare C, Vieweg A, et al. Efficacy and safety of low-dose regimens of conjugated estrogens cream administered vaginally. Menopause. 2009;16:719–27.

    Article  PubMed  Google Scholar 

  13. Suckling J, Lethaby A, Kennedy R. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev. 2006;(18):CD001500.

    Google Scholar 

  14. Long CY, Liu CM, Hsu SC, Wu CH, Wang CL, Tsai EM. A randomized comparative study of the effects of oral and topical estrogen therapy on the vaginal vascularization and sexual function in hysterectomized postmenopausal women. Menopause. 2006;13:737–43.

    Article  PubMed  Google Scholar 

  15. Al-Baghdadi O, Ewies AA. Topical estrogen therapy in the management of postmenopausal vaginal atrophy: an up-to-date overview. Climacteric. 2009;12:91–105.

    Article  CAS  PubMed  Google Scholar 

  16. Krause M, Wheeler 2nd TL, Snyder TE, Richter HE. Local effects of vaginally administered estrogen therapy: a review. J Pelvic Med Surg. 2009;15:105–14.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Labrie F, Archer D, Bouchard C, Fortier M, Cusan L, Gomez JL, et al. Effect of intravaginal dehydroepiandrosterone (Prasterone) on libido and sexual dysfunction in postmenopausal women. Menopause. 2009;16:923–31.

    Article  PubMed  Google Scholar 

  18. Labrie F, Archer D, Bouchard C, Fortier M, Cusan L, Gomez JL, et al. Intravaginal dehydroepiandrosterone (Prasterone), a physiological and highly efficient treatment of vaginal atrophy. Menopause. 2009;16:907–22.

    Article  PubMed  Google Scholar 

  19. Labrie F, Archer D, Bouchard C, Fortier M, Cusan L, Gomez JL, et al. Serum steroid levels during 12-week intravaginal dehydroepiandrosterone administration. Menopause. 2009;16:897–906.

    Article  PubMed  Google Scholar 

  20. Moegele M, Buchholz S, Seitz S, Ortmann O. Vaginal estrogen therapy in postmenopausal breast cancer patients treated with aromatase inhibitors. Arch Gynecol Obstet. 2012;285:1397–402.

    Article  CAS  PubMed  Google Scholar 

  21. Labrie F, Cusan L, Gomez JL, Côté I, Bérubé R, Bélanger P, et al. Effect of one-week treatment with vaginal estrogen preparations on serum estrogen levels in postmenopausal women. Menopause. 2009;16:30–6.

    Article  PubMed  Google Scholar 

  22. Portman DJ, Bachmann GA, Simon JA, Ospemifene Study Group. Ospemifene, a novel selective estrogen receptor modulator for treating dyspareunia associated with postmenopausal vulvar and vaginal atrophy. Menopause. 2013;20:623–30.

    PubMed  Google Scholar 

  23. Bachmann GA, Komi JO, Ospemifene Study Group. Ospemifene effectively treats vulvovaginal atrophy in postmenopausal women: results from a pivotal phase 3 study. Menopause. 2010;17:480–6.

    PubMed  Google Scholar 

  24. Karaosmanoglu O, Cogendez E, Sozen H, Asoglu MR, Akdemir Y, Eren S. Hyaluronic acid in the treatment of postmenopausal women with atrophic vaginitis. Int J Gynaecol Obstet. 2011;113:156–7.

    Article  PubMed  Google Scholar 

  25. Ekin M, Yaşar L, Savan K, Temur M, Uhri M, Gencer I, et al. The comparison of hyaluronic acid vaginal tablets with estradiol vaginal tablets in the treatment of atrophic vaginitis: a randomized controlled trial. Arch Gynecol Obstet. 2011;283:539–43.

    Article  CAS  PubMed  Google Scholar 

  26. Chen J, Geng L, Song X, Li H, Giordan N, Liao Q. Evaluation of the efficacy and safety of hyaluronic acid vaginal gel to ease vaginal dryness: a multicenter, randomized, controlled, open-label, parallel-group, clinical trial. J Sex Med. 2013;10:1575–84.

    Article  CAS  PubMed  Google Scholar 

  27. Lee YK, Chung HH, Kim JW, Park NH, Song YS, Kang SB. Vaginal pH-balanced gel for the control of atrophic vaginitis among breast cancer survivors: a randomized controlled trial. Obstet Gynecol. 2011;117:922–7.

    Article  PubMed  Google Scholar 

  28. Chism LA. Overcoming resistance and barriers to the use of local estrogen therapy for the treatment of vaginal atrophy. Int J Womens Health. 2012;4:551–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Jefferson Medical College, Jefferson University Hospitals, 834 Chestnut St., Suite 400, Philadelphia, PA, 19107, USA

    Ryan Sobel MD

  2. Division of Infectious Diseases, Department of Internal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, MI, USA

    Jack D. Sobel MD

Authors
  1. Ryan Sobel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jack D. Sobel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ryan Sobel MD .

Editor information

Editors and Affiliations

  1. Procter & Gamble Co., Cincinnati, Ohio, USA

    Miranda A. Farage

  2. Procter & Gamble Co., Cincinnati, Ohio, USA

    Kenneth W. Miller

  3. School of Nursing, University of Washington, Seattle, Washington, USA

    Nancy Fugate Woods

  4. Department of Dermatology, University of California School of Medicine, San Francisco, California, USA

    Howard I. Maibach

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Sobel, R., Sobel, J.D. (2015). Atrophic Vaginitis in the Menopause. In: Farage, M., Miller, K., Fugate Woods, N., Maibach, H. (eds) Skin, Mucosa and Menopause. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-44080-3_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-44080-3_14

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-44079-7

  • Online ISBN: 978-3-662-44080-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation