Related Topics: Menopause

How Vaginal Atrophy Can Affect You

This can affect up to 50% of menopausal women. It is important to be able to recognise the symptoms and changes that can develop in order to be able to effectively treat it.

Dr Tony Coope

Of all the symptoms of the menopause, the one that is usually the last to be talked about by both women and their doctors, and yet may go on to cause unnecessary and serious problems in their health and well-being, is that of vaginal atrophy (VA).

The importance of this condition in the menopause and beyond has recently been emphasized by the International Menopause Society (IMS), which released a new ‘Recommendations for Management” to mark World Menopause Day.  Calling for doctors to raise the topic with their postmenopausal patients and encouraging women themselves to seek medical advice, the recommendations shed a welcome light on a neglected area of women’s health.


Up to 50% of menopausal women may develop the symptoms and changes of VA, so the condition is much more common than is usually recognized or acknowledged. The recent VIVA (Vaginal Health: Insights, Views & Attitudes) online study of 3,500 postmenopausal women from Europe and the USA revealed that up to half of these could not discuss their symptoms with a doctor.

Only two out of five would talk to their partners, and two-thirds reported that their mother had never spoken to them about the menopause.

Knowing what to look for is the first step, and symptoms to keep an eye on are:

  • vaginal dryness
  • itching or burning
  • discomfort or pain during sex
  • an increased tendency to inflammation and infection
  • loss of bladder control

The study also showed that the majority of women misinterpreted some or all of these symptoms as being due to other conditions such as thrush or recurrent bladder infections, although these may, of course, appear as a consequence of VA.

Many women are not aware that VA is a chronic condition, and may tend to resort to moisturisers and lubricants which can give temporary relief, but without addressing the underlying cause.

The sad thing is that while many women do not seek advice due to justifiable concerns about taking oral HRT, and some may be reluctant to discuss matters that they see as personal and private, local treatment of VA is safe, effective and readily available.

Why VA Occurs

Due to a fall in oestrogen levels by up to a half, or even to as low as one twentieth of pre-menopausal levels, there occurs a thinning of the epithelial lining of the vagina, a loss of elasticity and a reduction in both the volume and acidity of vaginal secretions.

This leads to a relative dryness and tendency to recurrent infections and inflammation, and the same changes may affect the urethra and bladder.

If the underlying problem is not identified early, these changes may become chronic and ultimately resistant to further treatment, leading to quite serious long-term problems, including frequency, urgency and incontinence.


Local oestrogen therapy using oestriol or oestradiol can be applied as pessaries, cream or a slow-release vaginal ring, the hormone being well-absorbed through the vaginal wall, but with minimal absorption into the body’s general circulation.

Complementary approaches such as phytoestrogens (eg soy, red clover and black cohosh isoflavones) can be useful and both oral vitamin E and the omega 3 in fish oils have been found in some trials to improve vaginal lubrication.

Some women have found that the additional use of a bio-identical natural progesterone cream has benefit where itching or burning (inflammation) is present.

Vaginal atrophy is usually a simple and treatable condition if reported at an early stage. If treatment is delayed, the result may be changes which affect a woman’s health, self-esteem, body image, personal relationships, sexual intimacy and overall quality of life.

Avoiding these undesirable consequences should be a simple matter, but clearly there is a significant taboo around this subject that prevents many women, from seeking help.

Helpful information:

If you are suffering from vaginal dryness, rather than atrophy, then a combination cream of both progesterone and oestrogen such as 20-1 can be helpful. For atrophy initially this will not be sufficient oestrogen so a supplementary form from a doctor will be needed.

However once the initial condition is treated with a separate oestrogen, and is then stable, a combination cream can be used on its own.


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Comments 12
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AnnA Rushton | 10:23 am, September 8th, 2018

Lynne you need vagifem for vaginal atrophy but yes you can use 20-1 locally to help but not at the same time as the vagifem.

Lynne | 3:29 pm, August 29th, 2018

To soothe burning sensation can I use estriol or bio identical hormone creams like serenity or 20-1 locally or please advise what to use. I’m allergic to Ovestin oestrogen cream using locally so went to emuaid. But it doesn’t have oestrogen in it. I use vagifem daily which helps vaginal atrophy. Taking too long to get pain free

AnnA Rushton | 11:06 am, September 23rd, 2016

We can’t advise you on prescription drugs Heather you do need to speak to your doctor, however you may find 20-1, which is a combination cream with the majority ingredient of progesterone with two natural oestrogens added is more effective for you than just progesterone alone, as in Serenity.

Heather | 6:34 pm, September 22nd, 2016

I had Vaginal Dryness even though I was using Estriol cream. I also used Biodentical Progesterone cream twice a day. When I reduced the Progesterone to once a day the dryness went away. However, a year on and now it has returned even though still use the Estriol (Gynest) cream and progesterone. I wondered should I change to Vagifem, and would it be safe to use I am 66 years. Thank you.

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Dr Tony Coope | 11:09 pm, June 24th, 2011

sj: even if everything else is fine, it’s still very much worth treating VA, as this will minimise the risk of any progression to chronic inflammation, recurrent infections and symptoms related to the urethra and bladder (frequency, urgency, waking at night and even incontinence), which can become resistant to treatment the longer they continue. It also reduces the risk of these symptoms being mis-diagnosed as recurrent cystitis, and antibiotics being repeatedly and unnecessarily prescribed.
Standard estrogen therapy in the form of Gynest or Vagifem is safe and effective, and you can also apply progesterone cream where there is inflammation. There is now a 20:1 combined progesterone/estrogen cream available, which I think will be worth assessing.

sj | 5:37 pm, June 24th, 2011

I am 63 and not married or otherwise sexually active . I went through menapause about 10 yrs ago. I now am dealing with vaginal atrophy and have just been living with it because not sexually active. But maybe I should do something about it now , since i have heard about bio identical hormons. It would be nice to have a little more muscle tone down there even if I am the only one who knows about it right now. Can you tell me if this is a good treatment for it? I feel just fine, no more hot flashes or other symptoms other than the atrophy .

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