Diagnosis and Treatment of Vaginal Atrophy in Menopausal Women

middle aged woman sitting on bed

Do you experience vaginal itching, discomfort with intercourse, or urinary burning and leaking? It’s possible you may be experiencing atrophic vaginitis (AV).  AV is a common but annoying condition women have when their estrogen levels decline such as in menopause. It’s the thinning and drying of the vaginal tissue which can lead to these symptoms. Discussing this concern with medical providers is difficult but necessary in order to get proper treatment. Several over the counter vaginal lubricants are available but they usually offer insufficient therapy over time. Local application of estrogen is the ideal treatment for AV.

About half of menopausal women experience AV although most women do not seek treatment. A consult with a practitioner can result in a treatment regimen that can be satisfactory and offer fast relief. Sexual intercourse, with or without a partner, is one of the best ways to prevent AV because the vaginal mucosa is stimulated to expand and lubricate thereby preventing thinning of the tissue. The greatest risk factor is smoking because it diminishes oxygen in blood circulation and decreases estrogen levels in the body.

Testing and Diagnosis

This condition does not require extraordinary testing. When a patient consults her provider to address her symptoms of AV, after a thoughtful discussion, the clinician will do an exam to assess the vaginal tissue, the pH, and the cells in her discharge under a microscope. When the diagnosis of AV is made, appropriate therapy may be started right away.


Replacing vaginal estrogen is by far the most effective treatment for AV but it is not without risks. Estrogen replacement is not recommended for women who have had breast, uterine, or ovarian cancer. That being said, there are very low risk estrogen therapies that are effective and should be considered. Because AV is not a systemic condition, local therapy is the preferred treatment either with vaginal creams, tablets, suppositories or a vaginal ring. Commercial products such as Premarin, Estring and Estrace vaginal cream can treat AV and may be covered by insurance. Specially compounded medications may be formulated for women who have sensitivities to commercial products, need specific dosing, or need hypoallergenic bases for their estrogen therapy.

Estriol is a very weak estrogen that is typically prominent in pregnancy which prepares the vaginal mucosa for a vaginal delivery. In menopause compounded estriol is very effective in restoring the vaginal tissue to comfort and treat unwanted vaginal dryness and burning. A tailored dose of compounded estriol has a very low risk profile and offers excellent therapy in a relatively short time. It can be formulated in a cream or vaginal suppository and used two or three times a week to arrest both urinary symptoms and improve comfort with intercourse and vaginal health.

Women do not need to shy away from managing the health of their vagina. Therapies to treat AV are many and consulting their health care provider can improve the quality of their life with appropriate attention and guidance.

About the Author

Jay Reighley, APRN

As a nurse practitioner, Jay has spent 30 years practicing women’s healthcare in Southern Maine employing integrated approaches to healing imbalances in the body. She supports managing hormonal changes such as PMS, perimenopause and menopause, addressing sexual dysfunction and libido concerns, treating adrenal fatigue using natural remedies, providing comprehensive nutritional evaluation and guidance in healing gut dysfunction and provides complimentary approaches in treating chronic illness. Outside of practicing healthcare, Jay can be found paddling her kayak, sailing Casco Bay, hiking in the White Mountains, skiing Sugarloaf, tending her garden, running in the woods with her black labrador, beading, or just hanging out with her family.


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