Materiały źródłowe

• #1 Vaginal atrophy – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/diagnosis-treatment/drc-20352294

  Diagnosis of genitourinary syndrome of menopause (GSM) may involve: […] Pelvic exam, during which your doctor feels your pelvic organs and visually examines your external genitalia, vagina and cervix. […] Urine test, which involves collecting and testing your urine, if you have urinary symptoms. […] Acid balance test, which involves taking a sample of vaginal fluids or placing a paper indicator strip in your vagina to test its acid balance. […] In a pelvic exam, your health care provider inserts two gloved fingers inside your vagina. Pressing down on your abdomen at the same time, your provider can examine your uterus, ovaries and other organs. […] Your doctor will ask questions about your symptoms and assess your hormonal status. Questions your doctor may ask include: What vaginal or urinary symptoms have you noticed? […] Have you tried any over-the-counter moisturizers or lubricants?

• #2 Vaginal Atrophy: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15500-vaginal-atrophy

  Vaginal atrophy is a condition where the lining of your vagina gets drier and thinner. This results in itching, burning and pain during sex, among other symptoms. The condition also includes urinary tract problems such as urinary tract infections (UTIs) and urinary incontinence. […] A healthcare provider can diagnose vaginal atrophy based on your symptoms and a pelvic exam to look at your vagina and cervix. Classic signs of atrophy during a pelvic exam include: A shortened or narrowed vagina. Dryness, redness and swelling. Loss of stretchiness. Whitish discoloration to your vagina. Vulvar skin conditions, vulvar lesions and/or vulvar patch redness. Minor cuts (lacerations) near your vaginal opening. Decrease in size of the labia. […] While healthcare providers typically rely on examinations to diagnose atrophic changes or GSM, they may do the following tests to rule out other conditions: Pap test. Urine sample. Ultrasound. Vaginal pH (acid test). Vaginal infection testing.

• #2 Genitourinary Syndrome of Menopause – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559297/

  Clinicians should ask about obstetric and gynecologic histories, menstrual history, current and past medications, and the use of any potential irritants in the area. […] Laboratory tests such as urinalysis and culture, sexually transmitted infection testing, and vaginal pathogen swabs may be employed to rule out genitourinary infections; they are typically not necessary for diagnosing GSM. […] In 2020, the Menopause Society clarified that these laboratory tests are not essential for diagnosing GSM. […] The differential diagnosis of GSM is essential for distinguishing it from other conditions with overlapping symptoms. Accurate diagnosis involves a thorough patient history, physical examination, and appropriate diagnostic tests to differentiate GSM from other conditions.

• #2 Vaginal Atrophy: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15500-vaginal-atrophy

  You dont have to just live with vaginal atrophy. Even if youre in menopause or postmenopausal, that doesnt mean you should have to deal with UTIs, vaginal itching or painful sex. Treatment for GSM can be very successful. […] Vaginal atrophy cant be cured, but you dont have to live with the discomfort. With proper diagnosis and treatment, the symptoms can be managed. […] Yes, it can. Thats why prompt treatment is important. The sooner you get treatment, the less likely it is that your vaginal atrophy will worsen. For example, the longer you go without estrogen, the dryer your vagina will become. Without treatment, your vaginal atrophy may get worse. Occasionally, atrophy can become so severe that it can significantly narrow your vaginal opening. This may make it harder to treat the atrophy if treatment is started too late.

• #3 vulvovginal atrophy Archives – The ObG Project

  https://www.obgproject.com/tag/vulvovginal-atrophy/

  Genitourinary syndrome of menopause (GSM) is a composite of genital, urologic and sexual sequelae of chronic hypoestrogenism. […] Diagnosis should include the following on history: Irritants: Lubricants, powders, soaps, spermicides, panty liners; Hypoestrogenism: Oophorectomy, antiestrogen medications, radiation, chemotherapy. […] Ask about the following symptoms: Vulvovaginal: Itching, burning, pain, discharge, dyspareunia; Urinary: Frequency, dysuria, urgency, dribbling, incontinence, recurrent urinary tract infections. […] On pelvic exam look for the following: Pale vaginal epithelium with areas of erythema; Lacerations, stenosis, friable epithelium, labial fusion. […] Diagnostic tests should be individualized and risk-based: Vaginal pH (5-7 in GSM); Vaginal cytology (primarily basal cells); Wet mount; Cervical cytology; Depending on history and physical findings, other tests to consider: Transvaginal ultrasound; Hysteroscopy.

• #4 Vaginal Atrophy (Atrophic Vaginitis) – Harvard Health

  https://www.health.harvard.edu/a_to_z/vaginal-atrophy-atrophic-vaginitis-a-to-z

  Vaginal atrophy typically develops so slowly that a woman may not notice any symptoms until five to ten years after menopause begins. […] If you are a middle-aged woman, your doctor will ask whether you have started menopause or whether you have been experiencing menopausal symptoms (absent or irregular menstrual periods, mood swings, hot flashes, difficulty sleeping at night, night sweats). […] The doctor may suspect vaginal atrophy based on your age, symptoms and medical history. To confirm the diagnosis, the doctor will perform a pelvic examination to examine your vulva and vagina for signs of dryness, redness and thinning of tissue. […] If you are menopausal and have bleeding after intercourse, your doctor may want to check for endometrial cancer (cancer of the uterine lining) by doing an endometrial biopsy. […] Schedule an appointment with your doctor if you experience any vaginal bleeding, vaginal dryness, burning or itching, or if painful sexual intercourse is not relieved with a water-soluble lubricant.

• #5 What Is Vaginal Atrophy?

  https://www.icliniq.com/articles/womens-health/vaginal-atrophy

  Vaginal atrophy is a severe complication often overlooked and mistaken for regular urinary tract infections. […] Identifying the true cause and progression of vaginal atrophy is essential. Hence, adequate diagnosis and history of infections related to the urinary tract are crucial for the appropriate management and further advancement. […] For proper diagnosis of vaginal atrophy, the following steps are essential: Recording the case history correctly and asking for any contact with perfumes, deodorants, or soaps. Physical examination. Laboratory tests. In postmenopausal women, there is decreased estrogen, so a proper diagnosis is essential to differentiate it from other genital infections. Other vaginal bacterial infections cause similar symptoms. […] Physical examination of the vagina is done by using a speculum (a tool used for pelvic examination), which is lubricated. This is done to avoid discomfort for the patient and any injury to the vaginal tissues. Analysis reveals narrow vaginal canals with a width of less than two fingers. The vagina is dry with decreased depth. There is a reduction of elasticity in the vagina.

• #6 Postmenopausal Atrophic Vaginitis: Symptoms, Treatments and Causes

  https://www.healthline.com/health/atrophic-vaginitis

  See your doctor right away if sexual intercourse is painful, even with lubrication. You should also see your doctor if you experience unusual vaginal bleeding, discharge, burning, or soreness. […] Your doctor may refer you to a gynecologist for tests and a physical examination. During a pelvic exam, they will palpate, or feel, your pelvic organs. The doctor will also examine your external genitalia for physical signs of atrophy, such as: pale, smooth, shiny vaginal lining, loss of elasticity, sparse pubic hair, smooth, thin external genitalia, stretching of uterine support tissue, pelvic organ prolapse (bulges in the walls of the vagina). […] The doctor might order the following tests: pelvic examination, vaginal smear test, vaginal acidity test, blood test, urine test. […] The smear test is a microscopic examination of tissue that has been scraped from the vaginal walls. It looks for certain types of cells and bacteria that are more prevalent with vaginal atrophy.

• #7 Vaginal Atrophy: The 21st Century Health Issue Affecting Quality of Life

  https://www.medscape.org/viewarticle/561934

  Vaginal atrophy can be diagnosed with a detailed history and comprehensive physical examination. On physical examination, the vagina is dry, with pale, frail tissue, and lacking the normal mucosal ridges and folds. The expected elasticity and pliability associated with a well estrogenized vagina maybe absent. There is minimal lubrication due to decreased vaginal blood flow, and the tissues are easily traumatized with digital or pelvic examination. There may also petechiae or small hemorrhages on the vaginal lining. The vaginal introitus may be narrowed; the epithelial surface is typically very friable and may be ulcerated. […] As an adjunct to the physical examination, vaginal pH can be easily measured. It is typically greater than 5.0 in patients with atrophic vaginitis. Additional testing, including cytology and wet mount smears, can facilitate and substantiate diagnosis. Some sexual healthcare specialists are now using high-resolution vulvoscopy for further examination of vulvar tissue to exclude possible underlying pathology. A biopsy of any suspicious lesion should be performed and the sample sent for comprehensive pathologic assessment.

• #8 Vaginal Atrophy What Are the Symptoms, Causes, and Treatment

  https://gynagyn.com/blogs/news/vaginal-atrophy-symptoms-causes-and-treatment

  Vaginal Atrophy Diagnosis […] If you are experiencing pain during urination, during, and after sex, you should see your doctor. In addition, it’s essential to consider a doctor’s visit if you have tried over-the-counter treatments such as vaginal moisturizers, and they do not work. […] It’s also important to note that vaginal atrophy and yeast infections share symptoms such as itchiness, dryness, inflammation, and pain. However, yeast infections are fungal infections, while vaginal atrophy occurs because of a lack of estrogen. Consulting your Gynaecologist is the best way to confirm either of the conditions. […] The tests for vaginal atrophy or GSM may include: […] A pelvic examination: Your doctor inspects your pelvic organs through visual checks and physical touch to check for anomalies. This physical examination checks the visible and reachable parts of your genitalia, vagina, and cervix. During the physical examination, the doctor checks for whitening around your vaginal entrance, minor cuts and bruises on vaginal tissue, swelling, dryness, a bladder that’s lowered into your vagina, lesions (tissue injuries), and loss of pubic hair. […] A urine test: The sample of your urine is tested for urinary tract infection symptoms. […] An avid balance test: This simple test checks the pH of your vaginal fluids. […] Ultrasound and microscopy: An ultrasound or microscopy may be necessary to inspect internal tissue and organs.

• #9 Atrophic Vaginitis (Vaginal Atrophy): Causes, Treatment

  https://www.health.com/atrophic-vaginitis-8649704

  If you suspect you may be experiencing vaginal atrophy, you should visit a healthcare provider like an OB-GYN (a medical doctor specializing in female reproductive health and pregnancy) for an examination. These providers can typically diagnose the condition during a pelvic examination. […] During a pelvic exam, the OB-GYN will place an instrument called a speculum inside your vagina to slightly widen your vaginal walls, allowing them to examine your vagina and cervix. […] If your provider notices signs of atrophy, such as thinning vaginal walls, dryness, a pale color, and inflammation, they may diagnose you with vaginal atrophy. This pelvic examination, along with your age, menopausal status, and symptoms, is usually enough information to diagnose the condition. […] In some cases, your provider may need to rule out any other conditions that may be causing your symptoms. For example, they may test for sexually transmitted infections (STIs), urinary tract infection, and bacterial infections before giving a diagnosis.

• #10 Vaginal Atrophy/Genitourinary Syndrome of Menopause (GSM) | OB/GYN & Women’s Health | University Hospitals | University Hospitals

  https://www.uhhospitals.org/services/obgyn-womens-health/conditions-and-treatments/general-gynecology/vaginal-atrophy

  Vaginal atrophy, also known as genitourinary syndrome of menopause (GSM) or atrophic vaginitis, is a condition that causes thinning of the vaginal walls, leading to a range of symptoms that affect the vulva, vagina and urinary system. […] If you are experiencing unusual or unexplained symptoms of vaginal atrophy, make an appointment with your healthcare provider. They will be able to assess your symptoms and perform exams and tests to help diagnose vaginal atrophy. Tests may include: […] A pelvic exam to look for changes in your vulva, vagina and cervix. […] Pap test to look for abnormal cells in the cervix and screen for cervical cancer […] Urine test to look for problems such as a UTI […] Ultrasound to look at internal organs such as uterus, ovaries and bladder […] Vaginal pH test to examine the acid balance of the vagina.

• #11 What Is Vaginal Atrophy?

  https://www.webmd.com/menopause/vaginal-atrophy

  Your doctor will use three methods to diagnose the condition: […] Your doctor will get a urine sample for testing, especially if you have urinary issues. […] Your doctor will look closely at your genitals and feel inside to check your cervix. […] For this test, your doctor may use a paper strip to check the acid balance in your vagina.

• #12 Diagnosis and Treatment of Atrophic Vaginitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0515/p3090.html

  Up to 40 percent of postmenopausal women have symptoms of atrophic vaginitis. […] Despite the prevalence of symptoms, only 20 to 25 percent of symptomatic women seek medical attention. […] Therefore, physicians have an opportunity to improve the urogenital health and quality of life of a large patient population through identification of and intervention in this often overlooked and underdiagnosed condition. […] It is important not to assume a diagnosis of atrophic vaginitis (or solely a diagnosis of atrophic vaginitis) in the postmenopausal patient who presents with urogenital complaints. […] Laboratory diagnostic testing, including serum hormone levels and Papanicolaou smear, can confirm the presence of urogenital atrophy. […] Cytologic examination of smears from the upper one third of the vagina show an increased proportion of parabasal cells and a decreased percentage of superficial cells. […] An elevated pH level (postmenopausal pH levels exceeding 5) may also be a sign of vaginal atrophy. […] On microscopic evaluation, loss of superficial cells is obvious with atrophy, but there may also be evidence of infection with Trichomonas, candida or bacterial vaginitis.

• #13 Atrophic vaginitis: Symptoms, causes, and treatments

  https://www.medicalnewstoday.com/articles/189406

  Atrophic vaginitis is a type of genitourinary syndrome of menopause (GSM). […] How do doctors diagnose atrophic vaginitis? […] Diagnosis typically relies on a persons symptoms. The doctor may also order tests to confirm the diagnosis and rule out other possible causes. […] They may take the pH, or acidity, of the vaginal area. A pH of 4.6 or higher indicates atrophic vaginitis. […] If the diagnosis is unclear, or if the doctor suspects malignancy, they may order a biopsy to rule out cancer. […] It is best to contact a doctor if a person has concerns about atrophic vaginitis. The doctor can confirm the diagnosis and advise on treatments to help a person manage atrophic vaginitis.

• #14 Vulvovaginal Atrophy Following Treatment for Oncogynecologic Pathologies: Etiology, Epidemiology, Diagnosis, and Treatment Options

  https://www.mdpi.com/1648-9144/60/10/1584

  Vulvovaginal atrophy (VVA) is the thinning of vaginal and vulvar tissues, commonly due to reduced estrogen levels, particularly in postmenopausal women when estrogen decreases by 95%. […] The diagnosis of VVA is typically based on patient complaints, medical history assessment, and examination of external genitalia and vaginal mucosa. […] Most common complaints include vaginal dryness (64–100%) and dyspareunia (54.5–77.6%), followed by burning (38.3–61.7%), vulvar and vaginal itching (38.5–56.6%), and post-coital bleeding. […] Symptom assessment is reliable for diagnosing VVA, with around 90% of symptomatic women confirmed objectively. […] Vaginal pH measurement is an objective diagnostic tool, with VVA indicated by a pH > 5. […] The vaginal maturation index (VMI) evaluates estrogenization by analyzing epithelial cell types in a PAP smear. VVA is indicated by increased parabasal and intermediate cells and decreased superficial cells, with atrophy suggested if superficial cells make up less than 5%.

• #14 Vulvovaginal Atrophy Following Treatment for Oncogynecologic Pathologies: Etiology, Epidemiology, Diagnosis, and Treatment Options

  https://www.mdpi.com/1648-9144/60/10/1584

  Despite variations in diagnostic methods and criteria across studies, researchers generally agree that VVA can be confirmed when the following three criteria are met: (1) vaginal pH > 5 and a decreased VMI, (2) subjective reports of vaginal dryness and/or other VVA symptoms, and (3) at least one objective sign of VVA (such as mucosal dryness, pallor, decreased rugosity, fragility, or petechiae).

• #15 Vaginal Atrophy – MD Searchlight

  https://mdsearchlight.com/womens-health/vaginal-atrophy/

  What might be helpful is measuring your vaginal pH, which is a way of checking the level of acidity or alkalinity in your vaginal area. If your vaginal pH is above 5 and you don’t have any infections or unusual discharges, this could signal a problem. […] Vaginal atrophy, or thinning and inflammation of the vaginal walls, can be treated in a few different ways. These treatments can be grouped into non-hormonal and hormonal options. […] If these non-hormonal treatments don’t manage the symptoms effectively, hormone therapy might be necessary. […] Local estrogen therapy is usually started at lower doses. […] In most cases, HRT brings about improvement within 2 to 4 weeks of treatment, with continued response apparent after 12 weeks. […] The types of tests that may be needed to diagnose vaginal atrophy include: Urinalysis, Cultures of cells from the pelvic area, Urine antigen test, Vaginal pH measurement, Maturation Index Test.

• #15 Vaginal Atrophy – MD Searchlight

  https://mdsearchlight.com/womens-health/vaginal-atrophy/

  The doctor needs to rule out the following conditions when diagnosing Vaginal Atrophy: Infections in the vulva and vagina, such as yeast infections, bacterial vaginosis, and trichomoniasis. […] About 40% to 57% of women after menopause suffer from vaginal atrophy symptoms. […] Vaginal atrophy can be treated through non-hormonal and hormonal options.

• #16 Atrophic Vaginitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK564341/

  Atrophic vaginitis is an inflammatory process that occurs in clients experiencing vaginal atrophy. Diagnosis is made clinically based on symptoms. […] The exam reveals hypoestrogenic tissue with decreased secretions and elasticity, narrowing the introitus and being more susceptible to friction. […] The vaginal maturation index (VMI) is the proportional relationship between the superficial, intermediate, and parabasal cells of the vaginal tissue. A decrease in estrogen is associated with increased parabasal cells, resulting in lower VMI. The hypoestrogenic state is noted as a VMI of 0 to 49, however, the hyperestrogenic state is noted as a VMI 65 to 100. […] A proper diagnosis can be challenging without a dedicated history taking and physical exam, and misdiagnosis can lead to unnecessary referrals and procedures.

• #17 Atrophic vaginitis – Wikipedia

  https://en.wikipedia.org/wiki/Atrophic_vaginitis

  Diagnosis is typically based on symptoms. […] It can be challenging to diagnose atrophic vaginitis given that the symptoms are mild and nonspecific for many postmenopausal women. […] Diagnosis is based upon the symptoms that cannot be better accounted for by another diagnosis. […] To determine if atrophic vaginitis is the cause for a patient’s symptoms, differential diagnosis may be used. […] Lab tests usually do not provide information that will aid in diagnosing. A visual exam is useful. […] The vaginal pH will change from being acidic to a more neutral pH at around 4.5 or higher. […] The Vaginal Maturation Index (VMI) is a measure used to assess the composition of different types of cells in the vaginal lining. […] VMI is also a better measure of vaginal atrophy than patient-reported symptoms of vaginal dryness.

• #18 Atrophic Vulvovaginitis (Atrophic Vaginitis): A Complete Overview — DermNet

  https://dermnetnz.org/topics/atrophic-vulvovaginitis

  Should any tests be done to confirm the diagnosis? […] Tests may be performed in atrophic vulvovaginitis if any symptoms are present. These may include: […] Skin swab / wet mount examination this may reveal epithelial cells typical of postmenopausal vagina may be reported and can help identify infection […] Biopsy this may be done to make sure there is not an inflammatory skin disease or neoplastic condition causing symptoms […] Cystoscopy of the bladder and investigations for urinary symptoms […] Colposcopy of the vagina and cervix and investigations for gynaecological symptoms.

• #19 New guideline outlines best practices for managing genitourinary syndrome of menopause

  https://www.contemporaryobgyn.net/view/new-guideline-outlines-best-practices-for-managing-genitourinary-syndrome-of-menopause

  Diagnosis is based on patient-reported symptoms, including dryness, irritation, dyspareunia, and urinary complaints such as dysuria, urgency, and recurrent urinary tract infections. […] Physical signs such as labial atrophy, introital stenosis, or changes in vaginal pH may support the diagnosis but are not required. […] Clinicians are advised not to rely on hormone levels for diagnosis or management decisions.

• #20 New Innovations for the Treatment of Vulvovaginal Atrophy: An Up-to-Date Review

  https://www.mdpi.com/1648-9144/58/6/770

  Vaginal pH measurement, which is part of the VHI but also a useful assessment tool itself, is calculated through a pH indicator strip. […] Another tool used for VVA diagnosis, even if less successful in the literature than VHI, is the Vaginal Maturation Index (VMI). […] All the above-mentioned instruments are useful in the diagnostic process of VVA, but, as is evident, there is still no consensus on the definition of vaginal atrophy and, consequently, a unique diagnostic method. […] The differential diagnosis of VVA must be made with all the conditions that imitate the symptoms and clinical appearance, such as lichen sclerosus, lichen planus, and vulvar malignancies.

• #20 New Innovations for the Treatment of Vulvovaginal Atrophy: An Up-to-Date Review

  https://www.mdpi.com/1648-9144/58/6/770

  VVA is diagnosed via clinical evaluation and validated questionnaires. […] Considering the currently available literature, the most common assessment tools for GSM diagnosis are the visual analog scale (VAS) of VVA symptoms, the vaginal health index (VHI), and the female sexual function index (FSFI). […] While the VAS score is a progressive 10-point measure through which patients are asked to record their disturbances, the FSFI analyzes dyspareunia and general sexual disturbances with a six-domain structure form that includes questions about sexual desire, subjective arousal, lubrication, orgasm, satisfaction, and pain. […] The VHI is a score that incorporates the evaluation of five elements: vaginal elasticity, secretions, pH, integrity of the epithelial mucosa, and tissue hydration.

• #21 Diagnosis interstitial cystitis v vaginal atrophy

  https://www.menopausematters.co.uk/forum/index.php?topic=59950.0

  Only 2nd time posting but want others experience and opinions, since May this year had va symptoms, diagnosed myself asked gp for vagifem she obliged no questions asked (phone app) no examination done didn’t get on with it, tryed for 3 months had awful swelling, irritated bladder and burning much worse than original symptoms […] I went for examination yesterday evening, done by an experienced gp who I also like, she did a very detailed examination, said I have no obvious signs of va in fact I look very healthy there, only finding was a mild prolapse on the front vaginal wall but she said it was so mild it would not cause problems and to do kegals, she said her thoughts were interstitial cystitis going off examination and symptoms […] I think more va, gp now won’t give me any vaginal estrogen and I’m now worried the prolapse will get worse without any, and if it’s va in early stages this will get worse […] It does sound like GSM you may find you get some relief from following advice for self help for interstitial cystitis (in addition to what your GP has prescribed) while you’re obliged to do without vaginal oestrogen pending more expert help.

• #22 Vulvovaginal Atrophy (Genitourinary Syndrome of Menopause) – Vulvovaginal Disorders

  https://vulvovaginaldisorders.org/atlas_topic/atrophic-vaginitis/

  One must make sure of the diagnosis. Postmenopausal bleeding, if from the uterus or an unknown source, needs to be assessed with endometrial biopsy and pelvic ultrasound. Women whose symptoms are related to urination (frequency, urgency, dysuria) need to be assessed for urinary tract infection or other conditions of the bladder. […] Diagnosis is made clinically based on history, physical exam, and use of the maturation index via vaginal pH and wet prep with microscopy.

• #23 Genitourinary Syndrome of Menopause – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559297/

  Genitourinary syndrome of menopause (GSM) is a term that encompasses a wide range of symptoms and conditions associated with changes in the genital and urinary systems due to the decline in estrogen levels during menopause. […] GSM is highly prevalent, affecting over half of women who are postmenopausal, yet it remains underdiagnosed and undertreated. […] This activity reviews the identification, diagnosis, and management of GSM through a discussion of the physiological changes associated with menopause that lead to GSM, as well as the vast array of symptoms that can affect both the genital and urinary systems. […] Diagnosing GSM requires a comprehensive patient history and a thorough physical examination. Laboratory testing is not required. […] Many symptoms of GSM can be mistaken for other genitourinary conditions, such as vaginal or urinary tract infections, making it crucial for clinicians to obtain a detailed history, including a sexual history.

• #24 Genitourinary syndrome of menopause (vulvovaginal atrophy): Treatment – UpToDate

  https://www.uptodate.com/contents/genitourinary-syndrome-of-menopause-vulvovaginal-atrophy-treatment

  Vulvovaginal atrophy (VVA; also referred to as vaginal atrophy, urogenital atrophy, or atrophic vaginitis) results from estrogen loss and is often associated with vulvovaginal complaints (eg, dryness, burning, dyspareunia) in menopausal patients. […] In 2014, the new term genitourinary syndrome of menopause (GSM) was introduced by the International Society for the Study of Women’s Sexual Health and the Menopause Society. This term encompasses all of the atrophic symptoms patients may have in the vulvovaginal and bladder-urethral areas from loss of estrogen that occurs with menopause. […] Clinical manifestations and diagnosis of vaginal atrophy, as well as use of estrogen therapy for other menopausal symptoms, are discussed in detail separately. […] The primary indication for treatment of GSM is to relieve symptoms that cause distress in a patient who has diminished ovarian estrogen production due to menopause or other etiologies. Vulvovaginal symptoms include vaginal dryness, burning, pruritus, dyspareunia, vaginal discharge, bleeding, or spotting. Urinary tract symptoms include dysuria, urinary frequency, urethral discomfort, or, infrequently, hematuria. […] Many patients with GSM do not seek medical care for these issues (due to embarrassment, cultural, religious, or societal beliefs, or lack of awareness about safe and effective treatments) and many clinicians fail to ask their menopausal patients about GSM symptoms.

• #25 5 things every primary care provider should know about vaginal atrophy | MobileODT

  https://www.mobileodt.com/blog/5-things-every-primary-care-provider-should-know-about-vaginal-atrophy/

  Vaginal atrophy can cause considerable issues for postmenopausal women. This treatable condition can dramatically decrease the patients quality of life. It is estimated that only 25% of those who suffer from the condition will seek medical help. Primary care clinicians (PCP) should know about vaginal atrophy to respond quickly when patients present with possible symptoms. […] Vaginal atrophy is caused by decreasing levels of estrogen in menopausal women. […] Studies suggest that 25-50% of women experience vaginal atrophy. […] Only a quarter of those affected will seek medical treatment. […] The most common symptoms of vaginal atrophy include dryness (estimated at 75% of women), dyspareunia (estimated at 38%), and vaginal itching, discharge and pain (estimated at 15%). […] If a primary care physician is unsure about a potential case of vaginal atrophy, it is possible to receive professional support in their own clinic.

• #26 Current treatment options for postmenopausal vaginal atrophy | IJWH

  https://www.dovepress.com/current-treatment-options-for-postmenopausal-vaginal-atrophy-peer-reviewed-fulltext-article-IJWH

  Vulvovaginal atrophy (VVA) is a silent epidemic that affects up to 50%60% of postmenopausal women who are suffering in silence from this condition. […] However, according to research, only 25% of patients with the symptoms of VVA receive adequate therapy. […] Many patients are embarrassed to discuss intimate complaints with a specialist, which makes it difficult to verify the diagnosis in 75% of cases, and some patients regard the symptoms of VVA as manifestations of the natural aging process and do not seek help. […] Timely diagnosis and adequately selected therapy for the main symptoms of VVA lead to restoration and maintenance of the vaginal function and vaginal health. […] The diagnosis of VVA is made difficult by the low awareness of women about the pathological manifestations of the postmenopausal period and unwillingness/embarrassment to discuss the symptoms of an intimate character with the expert.

• #26 Current treatment options for postmenopausal vaginal atrophy | IJWH

  https://www.dovepress.com/current-treatment-options-for-postmenopausal-vaginal-atrophy-peer-reviewed-fulltext-article-IJWH

  Unfortunately, 75% of patients with the clinical manifestations of VVA do not seek help from specialists. […] The diagnosis is confirmed by vaginal examination and colposcopy, wherein atrophic epithelium and thin, pale, and easily traumatized petechial hemorrhages can be detected. […] It is necessary to carry out bacteriological studies, determine the acidity of the vaginal contents, perform cytological examination of the vaginal smears, and count the karyopicnotic index. […] The main therapeutic goal in managing VVA is to relieve symptoms and restore the vaginal environment to a healthy premenopausal state. […] Despite the high prevalence and negative impact on the quality of life, VVA is underreported by patients, undiagnosed by health care providers, and undertreated. […] Treatment should be started as early as VVA occurs and should be maintained over time. […] The diagnosis is confirmed by vaginal examination and colposcopy, wherein atrophic epithelium and thin, pale, and easily traumatized petechial hemorrhages can be detected.

• #27 Vaginal atrophy | Jean Hailes

  https://www.jeanhailes.org.au/health-a-z/vulva-vagina/vulval-vaginal-conditions/vaginal-atrophy

  Vaginal atrophy is usually diagnosed via a clinical examination. Your doctor will ask about your symptoms and medical history. They should check your vulva and vagina for signs of atrophy. If you have vaginal discharge, your doctor may take a vaginal swab to check for infection. If you have urinary symptoms, they may also order a urine (wee) test to check for a UTI. […] You cannot reverse vaginal atrophy, but you can stop it from getting worse by seeking a diagnosis and starting treatment early. Research suggests that MHT eliminates vaginal atrophy symptoms in 75% of cases, while vaginal oestrogen therapy is effective in 80% to 90% of cases. Without treatment, vaginal atrophy may get worse over time.

• #28 What is Vaginal Atrophy, and Can it be Reversed? | FemmePharma Consumer Healthcare

  https://femmepharma.com/what-is-vaginal-atrophy-and-can-it-be-prevented/?srsltid=AfmBOooEMqS5fbN8dnzfahrZCi62hyU9_CfS65Is_VcfqeIbCdfXwqYE

  When women in the perimenopausal, menopausal, or the post-menopausal years speak on the harrowing symptoms that accompany menopause, the least is said about the quasi-popular vaginal atrophy or the fact that it can be reversed. […] You can reverse symptoms of vaginal atrophy. […] It is not surprising that only 25% of women are receiving appropriate treatment for vaginal atrophy. […] All women will experience the natural and expected decline in estrogen upon entering menopause, but nonetheless, vaginal atrophy can be reversed with treatment. […] The earlier you begin treatment for vaginal atrophy, regardless of the severity of your symptoms, the better. […] Replacing depleted estrogen levels is the most effective and most prescribed treatment to reverse vaginal atrophy. […] Both systemic and topical hormone replacement therapy can help restore your vaginal lining and reduce vaginal dryness and discomfort. […] Lubricants and moisturizers are over-the-counter treatment options for vaginal atrophy. […] A relatively new option that seeks to reverse vaginal atrophy is laser therapy. […] Reversing symptoms is possible, which is why its vital to speak up and ask for help as soon as you notice symptoms.

• #29 Atrophic Vaginitis | Doctor

  https://patient.info/doctor/atrophic-vaginitis

  Atrophic vaginitis may be diagnosed by the practice nurse when a smear is being taken. […] Investigations may not be necessary if the diagnosis is clear and there are no clinical features causing concern. […] Assessment tools may be useful in evaluating severity of symptoms and their response to treatment. […] If symptoms have not improved with hormonal treatment, then another underlying cause of the symptoms should be considered (eg, dermatitis, vulvodynia).

• #30 Genitourinary Syndrome of Menopause: AUA/FUFU/AUGS Guideline (2025) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/genitourinary-syndrome-of-menopause

  GSM prevalence estimates in postmenopausal patients vary widely from 13 to 87 percent. […] This inconsistency stems from many factors including variation in the symptoms and/or signs assessed and evaluated, the symptom assessment tools used, and the demographics and settings of study populations. […] Unlike vasomotor symptoms of menopause (i.e., hot flashes and/or night sweats), the prevalence and intensity of some genitourinary symptoms, such as vulvovaginal dryness, increase with advancing age. […] Several organizations recommend identifying GSM through a case-finding approach, by screening patients for symptoms with routine questions. […] However, few tools have been validated for GSM assessment and existing tools are limited to vulvovaginal symptoms. […] The urinary symptoms associated with GSM are also linked with other common urologic conditions in older patients, such as overactive bladder (OAB), making identification, evaluation, and treatment of these symptoms complex.

• #30 Genitourinary Syndrome of Menopause: AUA/FUFU/AUGS Guideline (2025) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/genitourinary-syndrome-of-menopause

  A causal relationship between reduced hormone levels and urinary symptoms remains controversial. […] Nonetheless, the range of GSM treatments has increased substantially in recent years. […] Traditional therapies, such as vaginal estrogen, moisturizers, and lubricants restore, alleviate symptoms, or avoid friction, respectively. […] The strategies defined in this document were derived from evidence-based and consensus-based processes; however, shared decision-making is the optimal strategy to individualize level of impact and ultimate interventions. […] Clinicians should screen patients at risk for, or presenting with signs of, GSM for genital, sexual, and/or urinary symptoms using a focused medical, sexual, and psychosocial history. […] Patients with symptoms of GSM should undergo a genitourinary examination.

• #30 Genitourinary Syndrome of Menopause: AUA/FUFU/AUGS Guideline (2025) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/genitourinary-syndrome-of-menopause

  Clinicians should educate patients with GSM about genitourinary signs and symptoms that result from decreased sex steroid hormones. […] During evaluation of patients with GSM, clinicians should assess for coexisting genitourinary conditions, utilizing additional testing or referral when appropriate. […] In patients with GSM and psychosocial and/or sexual health concerns, clinicians may refer to a credentialed therapist. […] In patients with GSM and pelvic floor dysfunction, clinicians may refer to a physical therapist specializing in pelvic floor conditions. […] Clinicians should offer the option of local low-dose vaginal estrogen to patients with GSM to improve vulvovaginal discomfort/irritation, dryness, and/or dyspareunia. […] Clinicians should offer the option of vaginal dehydroepiandrosterone (DHEA) to patients with GSM to improve vulvovaginal dryness and/or dyspareunia.

• #30 Genitourinary Syndrome of Menopause: AUA/FUFU/AUGS Guideline (2025) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/genitourinary-syndrome-of-menopause

  Clinicians should recommend the use of vaginal moisturizers and/or lubricants, either alone or in combination with other therapies, to improve vaginal dryness and/or dyspareunia in patients with GSM. […] Clinicians should counsel patients that the evidence does not support the use of alternative supplements in the treatment of GSM. […] Clinicians should counsel patients to avoid vulvovaginal irritants and/or cleansers which may exacerbate the signs and symptoms of GSM. […] Clinicians should inform patients of the absence of evidence linking local low-dose vaginal estrogen to the development of breast cancer. […] For patients with GSM who have a personal history of breast cancer, clinicians may recommend local low-dose vaginal estrogen in the context of multi-disciplinary shared decision-making.

• #30 Genitourinary Syndrome of Menopause: AUA/FUFU/AUGS Guideline (2025) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/genitourinary-syndrome-of-menopause

  Clinicians should counsel patients with GSM that neither vaginal dehydroepiandrosterone (DHEA) nor ospemifene increase the risk for breast cancer. […] Clinicians should counsel patients with GSM that local low-dose vaginal estrogen does not increase the risk for endometrial hyperplasia with atypia or endometrial cancer. […] Clinicians should not perform endometrial surveillance in patients with GSM solely due to their use of local low-dose vaginal estrogen, vaginal dehydroepiandrosterone (DHEA), or ospemifene. […] After initiation of treatment, clinicians should reassess patients with GSM to monitor response. […] Clinicians should counsel patients receiving therapy for GSM that long-term treatment and follow-up may be required to manage signs and symptoms.

• #31 Practice Nursing – Vaginal atrophy: what is it and how can it be treated?

  https://www.practicenursing.com/content/clinical-focus/vaginal-atrophy-what-is-it-and-how-can-it-be-treated/

  Vaginal atrophy is a common, chronic and progressive condition that occurs due to oestrogen deficiency. […] Vaginal atrophy can be treated and the aims of treatment are to promote comfort and ensure that symptoms are reduced. […] Vaginal atrophy is a common condition for women in the menopause. […] It is estimated that vaginal atrophy affects 5080% of post-menopausal women and is caused by oestrogen deficiency, but it is an under-diagnosed and under-recognised condition. […] Vaginal atrophy and lack of lubrication can also occur at any time in a woman’s life and this happens in an estimated 15% of pre-menopausal women.

• #32 Diagnosis and Management of Vaginal Dryness in Menopause – Neliti

  https://www.neliti.com/publications/147472/diagnosis-and-management-of-vaginal-dryness-in-menopause

  Objective: To review the diagnosis and management of vaginal dryness in menopausal women […] Vaginal atrophy can be diagnosed in the form of vaginal dryness (75%), painful sexual intercourse (38%), itching and discharge complaints. […] Diagnosis can also be made by measuring the pH of the vagina by using litmus paper and vaginal cytology. […] Conclusion: Lack of estrogen causes vaginal atrophy with symptoms of vaginal dryness. Vaginal atrophy also causes urinary problems. Diagnosis is based on symptoms, examination of vaginal pH and vaginal cytology.

• #33 Vaginal Atrophy: Natural Treatments and More

  https://www.healthline.com/health/womens-health/vaginal-atrophy-natural-treatments

  Vaginal atrophy is inflammation, dryness, and thinning of the vaginal walls. […] Vaginal atrophy is better known as genitourinary syndrome of menopause (GSM). […] Some experts estimate that about half of all postmenopausal women experience vaginal atrophy. […] Your doctor may suggest medications or vaginal estrogen therapy for your GSM. […] Vaginal estrogen therapy can alleviate dryness, irritation, and painful intercourse. […] This is not a life-threatening disease. But it can interfere with and negatively affect your quality of life, if its not diagnosed and treated effectively. […] People who are diagnosed and treated often see improvement.

• #34 Do I Have Vaginal Atrophy? | Right as Rain by UW Medicine

  https://rightasrain.uwmedicine.org/well/health/vaginal-atrophy

  Vaginal atrophy can begin in the years leading up to or after menopause (or it may not happen at all). But knowing the symptoms can help you get properly diagnosed and treated. […] Symptoms can include vaginal itching, burning or dryness, recurrent urinary tract infections, and pain with intercourse, says Dr. Anna Kirby, a urogynecologist at the UW Medicine Pelvic Health Center. […] Talk to your primary care provider or gynecologist if you are experiencing symptoms of vaginal atrophy for correct diagnosis and treatment.

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