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Clinical manifestations and diagnosis of genitourinary syndrome of menopause (vulvovaginal atrophy)

Gloria Bachmann, MD
Richard J Santen, MD
Section Editor
Robert L Barbieri, MD
Deputy Editor
Sandy J Falk, MD, FACOG


Vaginal atrophy (also referred to as vulvovaginal atrophy, urogenital atrophy, or atrophic vaginitis) is characterized by dryness, inflammation, and thinning of the epithelial lining of the vagina and lower urinary tract due to loss of estrogen. Since vaginal atrophy often involves vulva and lower urinary tract, the term genitourinary syndrome of menopause has been introduced in those instances linked to menopause [1]. Although vaginal atrophy typically occurs in menopausal women, it can occur in women of any age who experience a decrease in estrogenic stimulation of the urogenital tissues. In premenopausal women, hypoestrogenic states include the postpartum period, lactation, hypothalamic amenorrhea, and during administration of antiestrogenic drugs.

Up to 70 percent of women with symptoms of vaginal atrophy do not discuss their condition with a health care provider [2]. Some because they believe their symptoms are an expected and necessary part of the aging process [3]. Cultural, religious, and societal beliefs may also play a role in making women feel uncomfortable discussing concerns related to the genitourinary system. In addition, many women are not aware of treatment options. Rather than seeking treatment, women commonly make lifestyle changes to deal with their symptoms. As an example, they may stop sexual activity due to dyspareunia caused by vaginal dryness.

Clinical manifestations and diagnosis of vaginal atrophy are reviewed here. Treatment of symptomatic vaginal atrophy, as well as use of estrogen therapy for other menopausal symptoms, is discussed in detail separately. (See "Treatment of genitourinary syndrome of menopause (vulvovaginal atrophy)" and "Treatment of menopausal symptoms with hormone therapy" and "Preparations for menopausal hormone therapy" and "Menopausal hormone therapy: Benefits and risks".)


Urogenital atrophy results from a decline in serum estrogen concentrations. In premenopausal women, estradiol is the predominant form of circulating estrogen. Serum estradiol concentrations in premenopausal women fluctuate during the menstrual cycle (figure 1), as follows:

Early follicular phase – an average of 50 pg/mL

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Literature review current through: Nov 2017. | This topic last updated: Jun 28, 2016.
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