Vaginal atrophy (also referred to as vulvovaginal atrophy, urogenital atrophy, or atrophic vaginitis) results from estrogen loss and is often associated with vulvovaginal complaints (eg, dryness, burning, dyspareunia) in menopausal women. Urinary frequency and recurrent bladder infections may also occur. The spectrum of adverse consequences makes long-term treatment essential in many women, not only for relief of symptoms, but also for the more troublesome problems that may occur, such as sexual dysfunction, postcoital bleeding, and recurrent urinary tract infections. Treatment options include both hormonal and nonhormonal interventions.
Treatment of symptomatic vaginal atrophy is reviewed here. Clinical manifestations and diagnosis of vaginal atrophy, as well as use of estrogen therapy for other menopausal symptoms, are discussed in detail separately. (See "Clinical manifestations and diagnosis of vaginal atrophy" and "Treatment of menopausal symptoms with hormone therapy" and "Preparations for menopausal hormone therapy" and "Menopausal hormone therapy: Benefits and risks".)
The primary indication for treatment of vaginal atrophy is the presence of symptoms that cause distress in a woman who is hypoestrogenic due to menopause or other causes. Vulvovaginal symptoms include: vaginal dryness, burning, pruritus, dyspareunia, vaginal discharge, bleeding, or spotting. Urinary tract symptoms include dysuria, urinary frequency, urethral discomfort, or, infrequently, hematuria. (See "Clinical manifestations and diagnosis of vaginal atrophy", section on 'Clinical manifestations'.)
Prior to initiating treatment for vaginal atrophy, other conditions should be excluded, in particular (See "Clinical manifestations and diagnosis of vaginal atrophy", section on 'Differential diagnosis'.):
●Women with postmenopausal bleeding should be evaluated for endometrial hyperplasia or cancer. (See "Evaluation of the endometrium for malignant or premalignant disease".)