How does vaginal atrophy occur?
Urogenital atrophy results in a decrease in the uterus, ovaries, vaginal canal and vulva. Endometrial atrophy is part of the process that leads to menopause. All the vaginal wall (including collagen, elastin and smooth muscle) undergo degeneration. The vaginal epithelium loses cells and thins.
Vaginal blood flow is reduced and associated with decreased lubrication during sexual arousal, as well as increased sensitivity to trauma and pain. The numbers of lactobacilli are declining and the vaginal pH is increasing, giving a better environment for colonization by pathogenic bacteria. The length and diameter of the vagina narrows, the vaginal cul-de-sacs disappear and the crests of the vagina fade. These changes are attributable to the decline in estrogen levels during menopause.
What are the treatments for vaginal atrophy by lifestyle modifications?
- Stop smoking: Smoking leads to increased metabolism of estrogen and is associated with increased rates of osteoporosis and vaginal atrophy.
- Regular sexual activity should be promoted to maintain vaginal health
It offers some protection against urogenital atrophy, presumably due to increased blood flow to the pelvic organs. It has also been shown that masturbation leads to increased genital blood flow in postmenopausal women, which may contribute to the maintenance of female sexual health.
What are the non-hormonal treatments that vaginal atrophy?
Replens (the only vaginal moisturizer available in Canada) had a beneficial effect equivalent to that of vaginal hormone replacement therapy, including positive changes in the index of maturation of the vaginal epithelium, as well as increased hydration and vaginal secretions. Replens, in comparison with vaginal replacement therapy, has shown equivalent improvements in vaginal itching and irritation, as well as in dyspareunia.
Several lubricants are available in Canada. None of these products exert long-term therapeutic effects.
What are the hormonal treatments for vaginal atrophy?
strong>General replacement hormone therapy
General hormonal therapy is indicated for women who want treatment for various symptoms associated with menopausal estrogen deficiency such as hot flashes and sleep disturbances, along with vaginal atrophy.
Local vaginal hormone therapy
- Estrogen cream,
- The intravaginal ring of estradiol
- Vaginal estradiol tablets.
Each of these forms of vaginal hormone therapy has been proven to reverse vulvovaginal atrophy and symptom relief.
Are there other treatment alternatives for vaginal atrophy?
Erbium Yag laser treatment of vaginal atrophy has been an innovative treatment in recent years, especially in Europe. This is a therapeutic process precisely controlled by Erbium Yag 2940 nm laser. It consists of a circumferential photothermal treatment of the entire lining of the vaginal canal wall. The laser triggers the production of collagen and improves the vascularization of the vaginal mucosa. It naturally restores the physiological state of the vaginal wall.