Treating Vulvavaginal Atrophy

Menopause is known for its hot flashes, the sweats, weight gain, and mood changes. But what about vaginal dryness?

Vulvovaginal atrophy commonly occurs during menopause, and its symptoms include irritated tissue, lack of lubrication, pain with urination, and pain with intercourse. These symptoms of vulvovaginal atrophy occur in as many as 45% of post-menopausal women. And yet, the majority of post-menopausal women feel uncomfortable discussing their symptoms with their healthcare providers.

Vulvovaginal atrophy significantly affects many women, altering their relationships and quality of life. In recognition of this, the North

American Menopause Society issued an update to their position statement on vulvovaginal atrophy from 2007. The original statement was limited to just vaginal estrogen, but the recent update addresses the multitude of therapies currently available for vulvovaginal atrophy. The treatment available for vulvovaginal therapy ranges from over-the-counter products to prescriptions.

First-line therapy for vaginal dryness symptoms includes simple vaginal lubricants and moisturizers, along with regular intercourse.

When patients are refractory to this first-line treatment, locally applied estrogen or systemic therapy is recommended. Ospemifene, a selective estrogen receptor modulator, is recently approved for moderate to severe pain during intercourse. If a woman is a survivor of breast or endometrial cancer, her choice of treatment for vulvovaginal atrophy should depend on a consultation with her oncologist and understanding of her needs and potential risks.

Ultimately, vulvovaginal atrophy commonly occurs among post-menopausal women in varied presentation, and women should not be afraid to discuss their symptoms with their healthcare providers. Clinicians should understand their patients’ preferences and needs, and they should be equipped to target these issues with one of the many therapies that currently exists.