Postmenopausal Vaginitis

(Atrophic Vaginitis)

Written by : Dr.M.D.Mazumdar, MD

Postmenopausal vaginitis is a condition in which decreasing levels of estrogen at the time of the menopause makes the vaginal mucosa thin and atrophic.

The low estrogen level decreases the immunity of the vaginal walls and leaves the mucosa unable to resist infections by pathogenic organisms.

This condition can occur not just after menopause, but also in the premenopausal period when the estrogen levels begin to decrease.

Also called 'Atrophic vaginitis', postmenopausal vaginitis may be accompanied by infections spreading upwards from the vagina to the uterus and downwards all around the vulva.

Signs and Symptoms of Postmenopausal Vaginitis

  • Vaginal Discharge

    The chief complaint is usually a thin or thick yellowish discharge, that may sometimes be bloodstained. The discharge seeps out to stain the undergarments brown. There is usually no smell, unless there is secondary infection by pathogenic organisms.

  • Vaginal Itching

    There may occasionally be severe itching of the vagina. This itching may primarily be due to the dryness caused by the atrophic condition of the vagina, or may be due to infection by organisms causing vaginal itching. In many postmenopausal women, vaginal itching may be the main complaint.

    Some women complain that the itching is so severe that they have to splash cold water on their genital organs in an attempt to control it. Others say that they have to rub themselves hard or press a pillow between their legs at night to control the itching.

  • Vaginal Discomfort

    Constant scratching can cause the vulva and vagina to be swollen with a throbbing discomfort. The vaginal opening may be sore and there may be a sense of fullness in the vulva.

  • Urinary Symptoms

    The soreness of the vulva may cause difficulty and pain in passing urine. There may be a sensation of incomplete emptying of the bladder and a desire to pass urine frequently.

  • Sexual Intercourse

    There may be pain and discomfort during sexual intercourse due to the soreness of the vagina. Dryness of the vagina due to lack of estrogen can also contribute to the discomfort.

  • On Examination

    On examination, the vulva as well as the vagina appears sore and inflamed. Signs of scratching may be seen. Small, reddish areas may be seen around the vault of the vagina (highest region) and the urethra (opening through which the urine is passed).

    Some women may have small patchy areas of ulcers on the vaginal walls. In an old and chronic case of infection, these ulcers may cause the walls of the vagina to stick together, leading to partial closure of the vagina.

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Diagnosis

Diagnosis of postmenopausal vaginitis is made only after ruling out all causes of postmenopausal bleeding. A diagnostic D&C (dilatation and curettage) of the uterine lining and the cervix to rule out cancers of the uterus and cervix is a must before starting any treatment.

Ultrasonography of the pelvic organs, examination of smears taken from the vagina and tests for hormone levels in the blood are other investigations usually done before starting treatment.

Treatment

  • Estrogens
  • The main aim of the treatment is to restore the normal vaginal resistance to infections. Estrogen may be given in the form of pills or creams. Premarin ointment containing estrogen (0.625mg per gram) may be applied inside the vagina thrice daily for 1 week. The dose is then decreased to two times a day for another 2 weeks, then once daily and then stopped.

    Premarin pills (1.25mg) can also be taken once a day for 3 weeks and then stopped. If the woman has an intact uterus (that is, if she has not had surgery to remove the uterus), she may have a mild bleeding for a few days within 1 week of stopping Premarin. Premarin is continued for another month if the symptoms persist, but is usually not necessary.

  • Treatment for infections
  • Treatment for specific infections like Trichomonas Vaginilis and Candida albicans, must be done only if the infecting organisms are identified. Usually, increasing resistance of the vaginal walls after using oestrogen are sufficient to control the infection.

  • General Treatment
  • Improving the general condition will contribute to the ability to resist infections.

    Supplements of various nutrients should be taken - B-Complex Capsules, High strength Multivitamin Capsules , Iron capsules to correct anaemia and Folic Acid tablets should be taken.

    Other supplementary vitamins and minerals that can increase the resistance of the body to infections of various types also need to be taken , especially since absorption and metabolism of nutrients and vitamins from the gut decreases at and around the time of the menopause.

    Vitamin C 500 mg tablets taken once daily and Zinc tablets helps increase the body's immunity to infection.

    Acidophilus tablets encourage the growth of healthy lactobacilli in the vagina and increases the acidity of the vagina to help prevent vaginal infections. Alternatively, a bowl of 200mg yogurt should be taken daily - this will not only help the growth of lactobacilli in the vagina and the gut, but is also a good source of calcium.

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