Atrophic vaginitis is a condition in which the vaginal tissue shrinks and becomes less moist because of a decrease in the hormone estrogen. It often results in feelings of dryness and subsequent pain in the vagina. While it is frequently associated with menopause, it may also occur in other conditions in which low estrogen occur, such as in response to certain medications or just after childbirth. There are several treatment options to help relieve the dryness and pain symptoms of atrophic vaginitis.
Moisturizers and Lubricants
One method of treating vaginal dryness without using hormones is to use vaginal moisturizers on a regular basis. Aloe is a common ingredient in these preparations and is used to provide moisturization. For sexual intercourse, it may be helpful for women to use a lubricant as well. These are water-, silicone- or oil-based liquids that are applied to the vagina just before sexual intercourse to help decrease the irritation that may be associated with intercourse. Some products may be useful both for long-lasting moisturizing as well as for use just before intercourse to provide extra lubrication. Some products are meant to be used several times weekly to provide long-term relief, while products used for shorter-term lubrication should be applied just before intercourse.
Estrogen-Containing Ring
A small ring containing estrogen is an effective way of providing a low dose of estrogen over the course of three months. The ring is inserted in the vagina, where it slowly releases a small amount of estrogen. After three months, a new ring is inserted. The advantage of using such a ring is that very little estrogen is absorbed by the body as a whole. Dr. Gloria Bachmann, of the University of Medicine and Dentistry of New Jersey/Robert Wood Johnson Medical School, and Dr. Richard Stanten, of the University of Virginia Health Sciences Center, estimate that less than 10 percent of the estrogen is absorbed throughout the body. This means that the side effects that would be expected if a woman were to take estrogen orally would be minimized.
Estrogen Tablets
An estrogen tablet that is inserted into the vagina is another way to increase the amount of vaginal estrogen in a post-menopausal woman with vaginal dryness. A 2008 study published by Dr. Gloria Bachmann and her colleagues found that a 25-mcg dose is slightly more effective at reducing vaginal dryness symptoms than a dose of 12.5 mcg of estrogen, which is a possible dose if the 25-mcg tablet is cut in half.
Eye-related Symptoms
If patients are not comfortable using estrogen-containing rings or vaginally-inserted estrogen tablets, another option to treat vaginal dryness is to use a cream that contains estrogen. The typical treatment regimen is 0.5 g of cream inserted with an applicator; this is done once daily for three weeks, and then application is reduced to twice a week. This regimen has been found to be effective in reducing symptoms of vaginal atrophy, such as vaginal dryness. However, according to a study published in the Journal of Clinical Endocrinology and Metabolism, blood levels of estrogen did not increase significantly. This suggests that most of the estrogen is only absorbed in the vaginal area, rather than being absorbed throughout the body.
References
- Obstetrics and Gynecology; Efficacy of low-dose estradiol vaginal tablets in the treatment of atrophic vaginitis: a randomized controlled trial; G. Bachmann et. al.; January 2008
- Journal of Clinical Endocrinology and Metabolism; Biological effects of various doses of vaginally administered conjugated equine estrogens in postmenopausal women; F.P. Mandel et.al.; July 1983
- UpToDate; Denise S. Basow; 2010
