II. Epidemiology

  1. Prevalence: 50% of post-menopausal women

III. Pathophysiology

  1. Related to decreased Estrogen with Menopause
  2. Vaginal effects
    1. Vaginal epithelium thins with decreased lubrication
    2. Vaginal canal narrowing
      1. Bleeding or pain on intercourse
    3. Vulvar mucosa thinning
      1. Vulvar burning or irritation
      2. Dyspareunia due to introitus narrowing
    4. Glycogen loss with altered Vaginal pH and flora

IV. Symptoms

  1. Vaginal irritation
  2. Dyspareunia
  3. Vulvar burning or irritation

V. Signs

  1. Urinary urgency
  2. Vaginal Discharge that is thin or clear
  3. Vaginal mucosa changes
    1. Mucosa is thin, pale and dry with reduced elasticity
    2. Vaginal rugae lost
    3. Mucosa may be irritated and friable

VI. Labs

  1. Vaginal pH 5 to 7

VII. Complications

VIII. Management

  1. See Menopause
  2. Symptomatic measures (first-line for mild symptoms)
    1. Vaginal Moisturizers (Replens) applied three times weekly
    2. Vaginal Lubricant (e.g. Astroglide) applied before intercourse
  3. Topical Vaginal Estrogen (second-line for moderate symptoms)
    1. Does not require systemic Progesterone (in intact Uterus) if used <1 year
    2. Low dose Topical Estrogen (e.g. Vagifem, Estring, Estrace or Premarin vaginal cream)
    3. Suckling (2006) Cochrane Database Syst Rev (4): CD001500 [PubMed]
  4. Systemic Estrogens (third-line for refractory symptoms)
    1. Precautions
      1. Do not use Unopposed Estrogen with intact Uterus (requires concurrent Progesterone)
    2. Continuous Estrogen Replacement
    3. Sequential Estrogen Replacement
    4. Transdermal Estrogen Replacement
    5. Higher dose Topical Estrogen (e.g. FemRing)
      1. Requires Progesterone (in intact Uterus), unlike low dose Topical Estrogens
  5. Other options (refractory symptoms and unable to use Estrogens)
    1. Osphena (ospemifene)
      1. Selective Estrogen receptor modifier (SERM) with Vaginal Estrogenic effect (unlike Raloxifene and Tamoxifen)
      2. Risk of venous thrombosis and Hot Flashes (similar to Raloxifene and Tamoxifen)
      3. Expensive ($160) with limited indications beyond other measures
      4. Dose: 60 mg once daily with food
      5. (2013) Prescr Lett 20(6):33

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Ontology: Postmenopausal atrophic vaginitis (C0156409)

Concepts Disease or Syndrome (T047)
ICD9 627.3
ICD10 N95.2
SnomedCT 156054004, 52441000
English Postmenopausal atrophic vaginitis, Postmenop atrophic vaginitis, postmenopausal atrophic vaginitis, postmenopausal atrophic vaginitis (diagnosis), Atrophic vaginitis, Senile (atrophic) vaginitis, Vaginitis;senile, atrophic vaginitis, Postmenopausal atrophic vaginitis (disorder), Senile atrophic vaginitis, Senile vaginitis, atrophic; vaginitis, postmenopausal, postmenopausal; atrophic vaginitis, postmenopausal; vaginitis, atrophic, senile; vaginitis, vaginitis; postmenopausal atrophic, vaginitis; senile, senile vaginitis
Dutch postmenopauzale atrofische vaginitis, seniele vaginitis, atrofisch; vaginitis, postmenopauzaal, postmenopauzaal; atrofische vaginitis, postmenopauzaal; vaginitis, atrofisch, seniel; vaginitis, vaginitis; postmenopauzaal atrofisch, vaginitis; seniel, Postmenopauzale atrofische vaginitis
French Vaginite sénile, Vaginite atrophique postménopausique
German senile Vaginitis, postmenopausale atrophische Vaginitis, Atrophische Kolpitis in der Postmenopause
Italian Vaginite senile, Vaginite atrofica postmenopausale
Portuguese Vaginite atrófica pós-menopáusica, Vaginite senil
Spanish Vaginitis atrófica postmenopáusica, Vaginitis senil, vaginitis atrófica posmenopáusica, vaginitis atrófica postmenopáusica, vaginitis atrófica senil (trastorno), vaginitis atrófica senil, vaginitis senil
Japanese 老人性腟炎, 閉経後萎縮性腟炎, ロウジンセイチツエン, ヘイケイゴイシュクセイチツエン
Czech Postmenopauzální atrofická kolpitis, Stařecká kolpitis
Korean 폐경기후 위축성 질염
Hungarian postmenopausalis atrophiás vaginitis, senilis vaginitis