Atrophic vaginitis

Question 1

What term is now used to replace atrophic vaginitis and other similar symptoms of menopause?

Answer 1

Genitourinary syndrome of menopause

(previously known as vulvovaginal atrophy, atrophic vaginitis, or urogenital atrophy)

Question 2

What is GSM?

Answer 2

GSM describes combined vulvovaginal and urinary tract symptoms caused by thinning and shrinking of the tissues of the vulva, vagina, urethra, and bladder caused by oestrogen deficiency.

Question 3

Who is most affected by atrophic vaginitis? When does it occur?

Answer 3

Atrophic vaginitis often occurs in women who are post-menopausal women.

Symptoms of urogenital atrophy may appear for the first time >10 years after the last menstrual period.

Question 4

What are the signs and symptoms of atrophic vaginitis?

Answer 4

• vaginal dryness,
• dyspareunia
• occasional spotting
• vagina may appear pale and dry O/E

Question 5

How does vaginal dryness change with time since menopause?

Answer 5

Vaginal dryness tends to increase in severity with time since menopause.

Question 6

What is the management of atrophic vaginitis?

Answer 6

1st line treatment is with vaginal lubricants and moisturisers

• Moisturisers e.g. Replens MD at least twice weekly
• Lubricants if insufficient vaginal secretions for comfortable sexual activity

2nd line: If these do not help then topical oestrogen cream can be used

3rd line: If this does not help seek specialist advice.

NB: lubricants/moisturisers can be used in combination with topical oestrogen creams. Topical oestrogen cream can be used in conjunction with HRT as some women may benefit.

Question 7

What are the complications of vaginal atrophy?

Answer 7

Dyspareunia, which can impact on libido (although this may also be due to declining levels of oestrogen and testosterone as the ovaries fail)

Question 8

How long can use of vaginal moisturisers and lubrincants be continued?

Answer 8

Indefinitely

Question 9

Is there an increase in breast cancer risk with low-dose vaginal oestrogen use?

Answer 9

For women using low-dose vaginal oestrogens, the evidence has not shown an increase in breast cancer in women with no history of breast cancer in the past (NICE CKS)

https://cks.nice.org.uk/topics/menopause/management/management-of-menopause-perimenopause-or-premature-ovarian-insufficiency/#non-hormonal-treatments

Question 10

What forms is low-dose vaginal oestrogen available in?

Answer 10

Low-dose vaginal oestrogen is available as:

• vaginal tablet (Vagifem®),
• creams (Ovestrin® or Gynest®),
• gel (Blissel®),
• pessary (Imvaggis®),
• vaginal ring (Estring®),

Choose depending on the woman’s preferences.

Question 11

With low-dose vaginal oestrogen use do you need to add progestogen?

Answer 11

A progestogen is not needed for endometrial protection, as systemic absorption of vaginal oestrogen is minimal.