Vaginal Atrophy Treatments

The best treatment for vaginal atrophy typically involves replacing lost hormones directly in the tissue. Vaginal atrophy is a condition where the skin thins and dries due to low estrogen levels. Treatments focus on restoring moisture using creams or rings to make the tissue healthy again. Early diagnosis and individually appropriate therapy enable women to regain comfort, enhance intimacy, and preserve long-term health.

This article outlines how therapeutics act, who will help, and how to access professional advice.

What is Vaginal Atrophy Treatment?

Treatment aims to put moisture and firmness back into the tissue. Vaginal atrophy happens when oestrogen levels drop and make the skin down there thin and dry.

A case study on vulvovaginal atrophy, led by Dr Iuliia Naumova from Saratov State Medical University, Russia, stated that although 60% of postmenopausal women develop symptoms, about 25% are appropriately managed. The study also mentioned treatments such as systemic and topically administered hormone replacement therapy, selective oestrogen receptor modulators, vaginal DHEA, and supportive use of lubricants and moisturisers. The case concluded that early diagnosis and suitable treatment chosen in time help restore vaginal functionality and ensure long-term vaginal health.

Treatments generally fall into two categories. Some are hormonal and others are non-hormonal. The hormonal measures involve local oestrogen therapy, systemically administered hormone replacement therapy (HRT), and drugs that target estrogen receptors. The non-hormonal measures consist of moisturisers, lubricants, dilators, and local anaesthetic creams.

Thus, therapy for vaginal atrophy yields relief in the short term as well as long-term restoration of vaginal well-being when tailored to individuals.

How Vaginal Atrophy Treatment Works and Who Needs It

Treatment for vaginal atrophy seeks to reverse changes in tissue typical for genitourinary syndrome of menopause (GSM), which develops as a result of declining levels of oestrogen. Low hormones cause the vaginal epithelium, or skin lining, to become thin and less stretchy, and more variable in pH, causing symptoms like dryness, feelings of burning, pain upon intercourse, and urinary symptoms. Treatment interventions consist either of the immediate resupply of estrogen to the tissue itself or the use of non-hormonal measures that improve moisture intake and overall comfort.

You might notice several common signs:

• Vaginal dryness and soreness
• Pain or dyspareunia upon intimacy
• Recurrent urinary tract infections (UTIs)
• Urinary frequency and urgency

A British Journal of Family Planning case report, led by Camil Castelo-Branco, et. al. from the Faculty of Medicine at the University of Barcelona, Spain, described the effectiveness of treating vaginal atrophy through the use of hormone replacement therapy (HRT). Locally administered HRT preparations include estradiol and estriol preparations. Symptomatic relief is typically observed between 1–3 months. Females are encouraged to choose that preparation in which they personally feel most comfortable.

Therapy for vaginal atrophy is successful for the majority of women, although selection is based on personal history and safety.

What Causes Vaginal Atrophy?

The most common cause of vaginal atrophy is a deficiency in estrogen. This condition tends to appear after menopause; it may also appear in women with early ovarian insufficiency, in lactating women, or after an oophorectomy, which is surgery to remove the ovaries.

Therapies for cancer, most notably chemotherapy, pelvic radiotherapy, or gynaecological surgery, also accelerate loss of tissue and loss of flexibility. Also, medicines such as aromatase inhibitors in breast cancer treatment worsen genitourinary syndrome of menopause. These associations are acknowledged in NICE’s guideline on menopause, advising vaginal oestrogen for urogenital symptoms.

According to Paula Briggs, on behalf of the Medical Advisory Council of the British Menopause Society, GSM is a “silent epidemic” where it’s underdiagnosed and undertreated. Lifestyle factors like smoking and sexual inactivity reduce blood circulation in vaginal tissue and tissue elasticity.

Common Symptoms of Vaginal Atrophy

Some of the most common symptoms of vaginal atrophy are vaginal dryness, itching, burning, and irritation. Dyspareunia (painful intercourse) is another common problem when the tissue is thinned and poorly lubricated. Urinary symptoms (urgency, frequency, stinging on urination) are also frequent warning signs. Meanwhile, recurrent urinary tract infections are caused by changes in vaginal flora.

According to Angelou K from Alexandra Hospital-National and Kapodistrian University of Athens, et al., these patterns of symptoms are described in interviews of GSM. Delicate vaginal tissue will bleed or spot after intercourse or pelvic exam because the skin tears easily. Symptoms tend to erode confidence, inhibit intimacy, and reduce daily quality of life. Per BMS consensus, numerous women hold off despite strong symptoms.

Early diagnosis and immediate application of vaginal atrophy treatment prevent complications and encourage regaining comfort and sexual health.

How Vaginal Atrophy is Diagnosed

The diagnosis of vaginal atrophy entails preliminary evaluation of symptoms and history with subsequent routine examination. Doctors evaluate alterations in vaginal tissue, along with urinary symptoms, and perform simple tests. Early and appropriate diagnosis leads to early intervention and forestalls late complications.

The following are the most common techniques doctors use to check you for Vaginal Atrophy:

Pelvic Exam

A pelvic examination enables physicians to feel visible alterations. Lesions usually consist of pale, dry, thin vaginal walls with decreased flexibility. Rarely, vaginal opening narrowing or tenderness occurs. These characteristics serve to confirm GSM and differentiate it from other conditions causing genital symptoms.

Acid Balance Test

Vaginal atrophy may be confirmed by assessing vaginal pH with an indicator strip. According to Vittoria Benini from the Vita-Salute University, Italy, et al, a value greater than 5.0 is highly linked with low levels of oestrogen after menopause and provides a quick, consistent diagnostic indicator in addition to symptoms and examination findings.

Urine Test

In most instances, symptoms are similar to those of bladder infections, and a urine test can be taken to rule out an infection. This is especially helpful if there’s stinging or urgency. If infection is excluded, symptoms are less likely to be due to cystitis than vaginal atrophy, prompting prescribers to consider local therapy.

Referral Considerations

Standardised questionnaires, such as the Vulvovaginal Symptoms Questionnaire, and symptom diaries may also be helpful in monitoring progress. A menopause expert should be consulted if initial treatment is not successful, if the woman’s history is complicated (e.g. if she has had breast cancer), or if diagnostic uncertainty remains.

What Happens When Vaginal Atrophy Goes Untreated

Untreated vaginal atrophy will gradually worsen. Ongoing dryness and discomfort lead to sexual avoidance, escalating relationship stress and growing distress. Chronic fragility may induce vaginal tears, bleeding, and recurrent inflammation, leading to other consultations and symptoms. Some observational cohorts had worsening symptoms develop over years after deferring therapy.

According to Themos Grigoriadis from the Urogynecology Unit, Alexandra Hospital-National and Kapodistrian University of Athens, et al., low levels of oestrogen decrease protective vaginal flora, leaving women open to recurrent UTIs as well as bladder symptoms. Investigators have linked untreated GSM with increased infections and urinary symptoms.

Aside from physical harm, prolonged discomfort and disruption to intimacy could catalyse anxiety, depressed mood, and lowered self-esteem. Progressive burden erodes quality of life. Getting help early prevents these consequences and protects physical and mental well-being.

Effective Treatments for Vaginal Atrophy Relief

Relief from vaginal atrophy is possible with numerous evidence-based choices. Medications can be hormonal or non-hormonal, locally or systemically administered, and individually specific. Investigation into these choices enables women to learn what to expect, from alleviation of symptoms to eventual restoration of vaginal health issues and comfort.

There are several ways to treat this condition.

Topical Oestrogen

Topical oestrogen is the main treatment choice in the UK. Provided as creams, pessaries, gels, or vaginal rings, it restores tissue elasticity, blood flow, and lubrication. There’s usually a noticeable improvement by 2–4 weeks, with the maximum effect occurring after several months. Minimal absorption into the bloodstream occurs, allowing for use over extended periods to be safe for most women.

Prasterone (Intrarosa)

Prasterone (Intrarosa) is a DHEA-based vaginal pessary. Once inside the vaginal tissues, DHEA is converted locally to oestrogen and testosterone. This enhances cell growth, restores moisture, and improves elasticity without significantly raising systemic hormone levels. It is great for treating dyspareunia, which is the medical term for pain during sex. Mild discharge or soreness is a side effect. Although licensed in Europe, it is not automatically available in the UK, and prescriptions are usually made by specialists.

Ospemifene (Osphena)

Ospemifene is a SERM, which is a type of drug that mimics the good effects of oestrogen. NICE guidelines confirm that ospemifene is licensed in the UK as the brand Senshio for women who cannot use vaginal creams. According to NICE surveillance, ospemifene is licensed in the UK (brand Senshio) for moderate–severe VVA in women not candidates for vaginal oestrogen. Reserving it is usually for women who are unable to use local oestrogen.

Vaginal Dilators

Non-hormonal vaginal dilators carefully open up vaginal tissue. They are very helpful if you have vaginismus, which is an involuntary tightening of the muscles. Dilators are typically introduced gradually under professional supervision and may be used with lubricants, with physiotherapy, or with local oestrogen.

Systemic Oestrogen Therapy

Systemic therapy means taking oestrogen as a patch or tablet to treat the whole body is recommended if GSM is associated with wider menopausal symptoms such as hot flushes. UK National Institute for Health and Care Excellence (NICE) (2015) recommends vaginal estrogen for urogenital symptoms. The guidelines make no distinction between preparations regarding safety or efficacy.

Topical Lidocaine

Topical lidocaine is a cream or gel that is directly applied to the vagina. It offers fast relief from stinging and pain, especially before intimacy or other medical procedures. Relief typically follows within a matter of minutes and lasts for several hours.

Compounded Medicines

Compounded medicines are custom-made hormone mixtures that are formulated for women who cannot tolerate normal products. In the UK, compounded vaginal treatments are not prescribed first-line due to a lack of rigorous regulation as licensed drugs. They are prescribed only when there is no licensed product.

When to See a Healthcare Provider for Your Vaginal Atrophy Treatment

Women must get professional advice if they get constant dryness, stinging or painful intercourse, or repeated urinary infections. Emergency evaluation is called for if unexpected vaginal bleeding occurs, or if they have intense pelvic pain or symptoms not relieved by front-line therapy.

Keeping a diary of symptoms and information about any previous treatments can help guide appointments and facilitate more personalised therapy. At Hormone Health, you’ll get expert opinion and multi-disciplinary therapy for your vaginal atrophy treatment plans. We encourage women to make evidence-based choices, from local oestrogen therapy to therapy without hormones, so they receive the best therapy for them.

You do not have to live with discomfort. Contact Hormone Health today to speak with a hormone specialist and find the right plan for you.