Vaginal Atrophy
Vaginal atrophy results from the natural decline in oestrogen levels and is recognised to be a progressive, long-term condition following the menopause.5
A range of terms are used to describe the genital and urinary symptoms of the menopause, including urogenital atrophy, genitourinary syndrome of menopause (GSM) and vulvovaginal atrophy.5,6,7 Vasomotor symptoms of the menopause (e.g., night sweats, hot flushes) will usually resolve without treatment, but the symptoms of vaginal atrophy do not.8 Symptoms are directly related to declining levels of oestrogen.9
Signs include raised vaginal pH, tissue colour changes, loss of tissue elasticity, loss of rugae and tissue fragility.9
Symptoms can range in severity from bothersome to debilitating.10
Vaginal dryness and dyspareunia (painful intercourse) are the most commonly reported symptoms11 but also include soreness, burning and itching.
Vaginal atrophy symptoms can have a significant impact on the QOL of women and their relationships with their partner.12 They may also negatively impact sleep and general enjoyment of life.12
In a survey of 1,000 UK menopausal and postmenopausal women with experience of one or more vulvar and/or vaginal atrophy symptoms13
• 61% said it interfered with intimacy,
• 66% said it interfered with sexual satisfaction,
• 62% said it interfered with sexual spontaneity,
• 56% said it interfered with partner relationships.
Early recognition and treatment has the potential to improve the sexual health and QOL of women and their partners.10,14
QOL scores demonstrate that moderate to severe vaginal atrophy has a similar level of impact to other chronic conditions such as arthritis, chronic obstructive pulmonary disease, asthma, and irritable bowel syndrome.15
Around half of postmenopausal women report experiencing genitourinary symptoms2 and local vaginal estriol has been shown to improve symptoms related to vaginal atrophy.16,17
Many women are unaware that their symptoms are a direct result of reduced oestrogen levels post menopause or that treatment is available.6
Vaginal atrophy is a chronic and progressive condition. After starting treatment it may take 3-4 months for noticeable improvement although symptoms may improve faster than this.5
The 2024 NICE Menopause Guideline continues to recommend offering vaginal oestrogen treatment for women with no history of breast cancer. NICE recognises that symptoms often come back when treatment is stopped so recommends treatment continues as long as necessary.18
Local vaginal oestrogen treatment is also supported by the British Menopause Society and a Cochrane Review.5,19
About 25% of women using systemic oestrogen may still experience genitourinary symptoms of the menopause and may benefit from also using a local vaginal oestrogen.5,9,18
Vaginal oestrogens have been shown to cause no increased risk of cardiovascular disease, endometrial cancer or breast cancer.20,21,22 It is unknown if low dose vaginal oestrogens stimulate the recurrence of breast cancer. Women should report any unexpected breast changes.
Vaginal estriol has no demonstrated increased risk of endometrial proliferation or hyperplasia.23 It is recommended that all vaginal oestrogen treatment should be reviewed at least annually for endometrial safety and women should report any vaginal bleeding or spotting.
UK-EST-06-24-00009 February 2025
