Materiały źródłowe

• #1 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. Vaginal atrophy develops secondary to a lack of estrogen due to menopause. […] Atrophic vaginal changes are caused by thinning vaginal epithelium, decreased vaginal rugae and elasticity, and decreased vaginal secretions. Atrophic vaginitis is a symptomatic inflammatory process involving the thinned vaginal epithelium affecting some pre-menopausal and up to 50% of post-menopausal women. […] The hypoestrogenic state results in the fusion of collagen fibers and fragmentation of elastin fibers in vulvovaginal tissue and decreased squamous cells, resulting in decreased mucosal elasticity and decreased rugae, and narrowing of the vagina. […] The consequence of elevated vaginal pH is a shift in normal flora, Lactobacilli spp., and more susceptible to other pathogens such as Gardnerella, Prevoltella, Atopobium, and Streptococcus.

• #1 Genitourinary Syndrome of Menopause | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/30935

  Estrogen plays a crucial role in maintaining the normal anatomy and physiology of the urogenital system. Estrogen receptors are present in the vagina, vulva, urethra, and bladder trigone, where they respond to estrogen stimulation by maintaining normal blood flow, tissue thickness, rugosity, elasticity, and moisture of epithelial surfaces. […] After menopause, the quantity of lactobacilli decreases, leading to an increase in the vaginal pH and the development of GSM. […] A decline in estrogen levels during menopause causes urogenital atrophy. As estrogen production decreases, secretions diminish, and the genitourinary tissues become atrophic, leading to the symptoms associated with GSM. […] Estrogen plays a critical role in maintaining healthy blood flow and a balanced microbiome in the vagina while maintaining the elasticity, thickness, and moisture of the vaginal epithelium by sustaining collagen levels. Estrogen also promotes the exfoliation of vaginal epithelial cells, leading to increased glycogen levels, which lactobacilli in the normal vaginal flora convert into lactic acid. This process allows for the renewal of the vaginal epithelium and maintains the vagina’s typical acidic pH. When estrogen levels decline, this process is disrupted, resulting in an atrophic vaginal epithelium with reduced secretions and a less acidic environment characterized by a pH greater than 5.

• #1 Genitourinary syndrome of menopause

  https://www.racgp.org.au/afp/2017/july/genitourinary-syndrome-of-menopause

  Genitourinary syndrome of menopause (GSM) is a more accurate and inclusive term that describes the multiple changes occurring in the external genitalia, pelvic floor tissues, bladder and urethra, and the sexual sequelae of loss of sexual function and libido, caused by hypoestrogenism during the menopause transition and postmenopause. These genitourinary changes primarily occur in response to reduced oestrogen levels and ageing, and do not settle with time. […] The loss of oestrogen causes anatomical and functional changes, leading to physical symptoms in all of the genitourinary tissues. The tissues lose collagen and elastin; have altered smooth muscle cell function; have a reduction in the number of blood vessels and increased connective tissue, leading to thinning of the epithelium; diminished blood flow; and reduced elasticity. Thinning is also related to the change in the vaginal epithelial cells. Premenopausally, the predominant cells are intermediate and superficial, and there are few parabasal cells, whereas after menopause, the number of parabasal cells increase, and sometimes there is an increase in intermediate cells and loss of superficial cells.

• #1 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. Because the condition is attributable to estrogen deficiency, it may occur in pre-menopausal women who take antiestrogenic medications or who have medical or surgical conditions that result in decreased levels of estrogen. The thinned endometrium and increased vaginal pH level induced by estrogen deficiency predispose the vagina and urinary tract to infection and mechanical weakness. […] After menopause, circulating estrogen levels (mainly estradiol), are dramatically reduced from greater than 120 pg per mL to around 18 pg per mL. Numerous cytologic transformations follow estrogen reduction, including proliferation of connective tissue, fragmentation of elastin and hyalinization of collagen. These changes may result in granulation, fissures, ecchymoses, telangiectases and ulcerations. Postmenopausal changes in tissue composition are not limited to the genital tract but also include the urinary tract because of the shared common embryologic origin. Vaginal and urethral epithelia are estrogen dependent and adversely change in an estrogen-deprived environment.

• #1 Pathophysiology of VVA – Flynn Forum

  https://flynnforum.com/womens-health/pathophysiology-of-vva/

  Vulvar and vaginal atrophy (VVA) is a relatively common condition symptomatically affecting approximately 50% of all postmenopausal women. Under hypoestrogenic conditions, the vaginal epithelium becomes thinner, its barrier function is lost, the vaginal folding decreases, the elasticity of the tissues decreases, and the secretory activity of the Bartholin glands decreases, which lead to traumatisation of the vaginal mucosa and painful sensations. These changes in vaginal epithelium also cause changes in the vaginal microbiota, resulting in increased urinary tract infections. Recurrent urinary tract infections occur in up to 20% of postmenopausal women because of atrophy of the urothelium in response to estrogen deficiency. Clinical findings include atrophy of the labia majora and vaginal introitus. The labia minora may recede. Vulvar and vaginal mucosae may appear pale, shiny, and dry; if there is inflammation, they may appear reddened or pale with petechiae. Vaginal rugae disappear, and the cervix may become flush with the vaginal wall. Vaginal shortening and narrowing tend to occur.

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

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

  With the advent of hypoestrogenism, the delicate nervous, muscular, and vascular mechanisms that regulate sexual function are disturbed. Estrogens, in fact, are involved in genital lubrication and trophism but also in complex brain networks that regulate sexual desire and satisfaction. The microstructural changes caused by the estrogen withdrawal are accompanied by major anatomical and functional alterations: the epithelium becomes pale and less elastic, the vagina can narrow and shorten, the labia minora regress, and the introitus may constrict, all leading to severe sexual dysfunction. […] Estrogens are also responsible for the maintenance of a physiological vaginal microbiome and a correct pH value. A healthy vaginal flora is characterized by a predominance of Lactobacillus species, which metabolizes glucose into lactic acid and acetic acid, lowering the vaginal pH to a range of 3.5–4.5 and protecting from vaginal and lower urinary tract infections. With the thinning of the vaginal epithelium due to menopause, fewer squamous cells are discharged into vaginal secretions, and those that are have lower glycogen content. As vaginal glycogen levels fall, the population of Lactobacilli decreases and the vaginal pH increases.

• #1 Vaginal atrophy: causes, symptoms and treatment | SEID Lab

  https://lab-seid.com/vaginal-atrophy-understanding-a-common-condition-in-women/?lang=en

  Vaginal atrophy can have a very significant impact on the quality of life of those who experience it. […] The symptoms associated with this condition can vary in intensity, but generally affect sexual comfort and well-being, as well as the overall health of the intimate area. […] Vaginal dryness is one of the most common symptoms of vaginal atrophy. Due to decreased oestrogen levels, vaginal tissue becomes thinner and less lubricated, which can cause discomfort and pain during intercourse. […] Pain or discomfort during sexual intercourse is known as dyspareunia. As a result of atrophic vaginitis, the tissues become more fragile and lose elasticity, making penetration difficult and causing pain or uncomfortable sensations during intercourse. […] Vaginal atrophy increases the risk of urinary tract infections, as reduced oestrogen can disrupt the balance of beneficial bacteria in the vaginal area.

• #1 Vaginal atrophy – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288

  Vaginal atrophy (atrophic vaginitis) is thinning, drying and inflammation of the vaginal walls that may occur when your body has less estrogen. Vaginal atrophy occurs most often after menopause. […] Genitourinary syndrome of menopause is caused by a decrease in estrogen production. Less estrogen makes your vaginal tissues thinner, drier, less elastic and more fragile. […] A drop in estrogen levels may occur: After menopause, During the years leading up to menopause (perimenopause), After surgical removal of both ovaries (surgical menopause), During breast-feeding, While taking medications that can affect estrogen levels, such as some birth control pills, After pelvic radiation therapy for cancer, After chemotherapy for cancer, As a side effect of breast cancer hormonal treatment. […] Although the condition is common, not all menopausal women experience GSM. Regular sexual activity, with or without a partner, can help you maintain healthy vaginal tissues.

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

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

  With the gradual loss of serum estrogen as women age, the epithelium of the vulva and vagina undergo atrophy (thinning of the tissue). In post-menopausal women, this is responsible for many of the symptoms of Genitourinary Syndrome of Menopause (GSM). […] The cause of atrophic vulvovaginal symptoms (GSM) is loss of estrogen resulting from menopause, castration, anti-estrogens (tamoxifen), or ovarian destruction. […] Natural menopause is the most common cause of vulvovaginal atrophy. With a thin, atrophic, vaginal epithelium, there is a shift in vaginal pH with values from >4.5 up to 7, and a shift in the vaginal maturation index from the superficial epithelial cells and robust lactobacilli of premenopause, to a preponderance of parabasal cells and absence of lactobacilli. […] Diagnosis is made clinically based on history, physical exam, and use of the maturation index via vaginal pH and wet prep with microscopy.

• #1 Vaginal Atrophy | Baylor Medicine

  https://www.bcm.edu/healthcare/specialties/obstetrics-and-gynecology/ob-gyn-conditions/vaginal-atrophy

  Vaginal atrophy is caused by a loss of estrogen. Less estrogen in the body makes the vaginal walls thinner, drier, less elastic and more fragile. […] Vaginal atrophy may occur: After menopause, During the years leading up to menopause (perimenopause), During breastfeeding, After surgical removal of both ovaries (surgical menopause), After pelvic radiation therapy for cancer, After chemotherapy for cancer, As a side effect of breast cancer hormonal treatment. […] Hormone treatment. To restore thickness and elasticity of vaginal tissues. Talk with your doctor about the risks and benefits.

• #1 Vaginal Atrophy

  https://comprehensive-urology.com/womens-health/vaginal-atrophy/

  Vaginal atrophy or atrophic vaginitis is the painful inflammation of the vagina as a result of the tissues becoming thin and shrinking, causing decreased lubrication, soreness, and itchiness. The condition is most often caused by a decrease in estrogen, such as after menopause or while breastfeeding. […] The main cause of atrophic vaginitis is a decline in the reproductive hormone estrogen, which results in the vaginal tissues becoming thin, fragile, dry, and less elastic. […] Additional risk factors associated with vaginal atrophy include smoking cigarettes or taking certain medications to decrease estrogen levels or treat endometriosis, breast cancer, fibroids, or infertility, such as Danocrine, Lupron, or Synarel. […] One of the most common and effective treatments for atrophic vaginitis is hormone replacement therapy, which can be administered either topically or orally.

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

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

  Vulvovaginal atrophy, characterized by the thinning of vaginal mucosa typically resulting from reduced estrogen levels, is frequently exacerbated by oncogynecologic treatments such as chemotherapy, hormonal therapy, radiotherapy, or surgery. […] Patients with oncogynecologic diseases undergoing hormonal therapy, systemic chemotherapy, radiotherapy, or surgery experience ovarian damage or removal, leading to estrogen deficiency and the onset or worsening of VVA symptoms. […] AIs inhibit estrogen production, while TX’s metabolite, endoxifen, acts as an estrogen receptor antagonist but stimulates alpha estrogen receptors in the vagina, potentially increasing secretions and reducing VVA risk. […] Radiotherapy (RT) is employed in the treatment of cervical, endometrial, and vaginal cancer. RT not only has gonadotoxic effects but also disrupts vaginal tissue vascularization and innervation, leading to fibrosis.

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

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

  Atrophic vaginitis, also known as vaginal atrophy, is when the tissues of the vaginal canal become thinner, often leading to dryness and inflammation. The condition occurs most commonly in people experiencing perimenopause or menopause due to the drop in estrogen that happens during menopause. […] Vaginal atrophy is caused by a drop in estrogen, which typically occurs in people who are going through or have completed menopause. Menopause, which is when you stop having menstrual periods, causes a 95% drop in estrogen production. Estrogen is responsible for maintaining vaginal physiology, including tissue strength, suppleness, and blood flow to the vagina. As estrogen drops, the vaginal walls become thinner, and vaginal lubrication decreases. […] Although vaginal atrophy happens most widely in people of menopausal age (around age 45-55), it can occur in people who have experienced early menopause, gone through cancer treatment, or had their ovaries removed. Other risk factors for vaginal atrophy include primary ovarian insufficiency (when the ovaries start to fail before age 40), ovarian failure, pituitary or thyroid disorders, and anti-estrogen medications. After childbirth and during breastfeeding, there is also a steep drop in estrogen, which can cause symptoms of vaginal atrophy or dryness for some people.

• #1 Understanding Vaginal Atrophy: Symptoms, Causes, And Treatment Options

  https://vaginal-rejuvenation.clinic/health/understanding-vaginal-atrophy/

  Atrophy of the vagina is a medical disorder in which the vaginal tissues become thin, dry, and less elastic. This issue can cause discomfort, pain, and a variety of other symptoms that can significantly influence a womans quality of life. […] A reduction in estrogen levels in the body is the cause of vaginal atrophy. This decline may be caused by natural aging, menopause, or other medical problems that influence estrogen levels. […] Vaginal atrophy can also be caused by a drop in estrogen levels, which can be a result of several factors including: Oophorectomy: The removal of both ovaries, where estrogen is primarily produced, can lead to a decrease in estrogen levels. […] Additionally, other factors such as smoking, lack of sexual activity, and not having vaginal births can increase the risk of vaginal atrophy.

• #1 Vaginal Atrophy: Causes, Symptoms and Treatment

  https://www.apollohospitals.com/diseases-and-conditions/everything-you-want-to-know-about-vaginal-atrophy/

  Vaginal atrophy is commonly found in women after menopause. […] In most cases of vaginal atrophy, the estrogen hormone levels drop by almost 85%. […] Low estrogen levels, which is often a part of the natural process of menopause, leads to vaginal atrophy. […] Some factors put you at more risk of developing vaginal atrophy, such as, smoking is known for adversely affecting your health. […] Untreated vaginal atrophy may lead to certain health complications. […] Signs of vaginal atrophy can be treated with products such as, vaginal lubricants: A doctor can prescribe water-based vaginal lubricants to soothe burning and inflammation. […] Vaginal atrophy can be managed with estrogen creams and systemic hormone therapy.

• #1 Genitourinary Syndrome of Menopause | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/30935

  Traditionally, estrogen has been recognized as the primary hormone responsible for the health and function of the vagina. However, increasing evidence suggests that androgens also play a crucial role in maintaining urogenital tissue health. The vagina contains androgen receptors that, when stimulated, help reduce inflammation and maintain vaginal contractility. After menopause, dehydroepiandrosterone (DHEA), a weak androgen primarily secreted by the adrenal glands, becomes the prominent sex steroid in the body. Within the vagina, DHEA is converted into both estrogens and androgens. This understanding has led to a newer approach to GSM treatment, including local androgen therapy with DHEA.

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

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

  Local estrogen therapy allows to quickly eliminate the symptoms of VVA, but it does not alleviate the vasomotor symptoms and reduce the risk of osteoporosis. […] The vaginal metabolism of DHEA into estrogens/testosterone leads to the activation of estrogen and androgen receptors in the three layers of the vaginal wall, including the fibers of the basal membrane collagen and the muscle wall, but the absence of aromatase in the normal endometrium does not lead to its stimulation. […] Laser therapy improves the vascularization of the vaginal mucosa, stimulates the synthesis of new collagen and matrix basic substance in the connective tissue, thickens the vaginal epithelium with the formation of new papillae, replenishes glycogen in the vaginal epithelium, allows restoring the balance of the mucosa and therefore improves the symptoms of atrophy caused by a lack of estrogen. […] Timely active detection of this pathological condition and providing adequately selected therapy can prevent the progress of the disease and significantly improve the quality of life and sexuality of women.

• #1 Vaginal microbiota transplantation alleviates vaginal atrophy in ovariectomized mice | Scientific Reports

  https://www.nature.com/articles/s41598-025-92881-1

  Previous studies have demonstrated that ovariectomy leads to thinning of the vaginal mucosa, reduces the number of vaginal epithelial cells, and decreases vaginal blood vessel density in mice. […] Treatment with estriol and VMT both improved vaginal atrophies, increasing vaginal epithelial thickness and the number of epithelial cell layers. […] VMT may use estrogen more efficiently to promote cell proliferation by upregulating vaginal epithelial ER expression. […] These results suggest that VMT may ameliorate vaginal inflammation by modulating the production of inflammatory factors. […] The results showed that the bilateral ovariectomy mouse model is appropriate for investigating the correlation between vaginal health and VM after ovariectomy. […] This study compared the microbiota structure and metabolites of VM between the two groups: the CON group and OVX group.

• #1 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 is a common condition for women in the menopause. It is chronic and progressive and will not get better without treatment over time, unlike vasomotor symptoms. […] 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.

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

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

  Vaginal atrophy can affect your quality of life and your relationship with your partner(s). There are physical and emotional side effects of GSM. Physical symptoms like pain, burning, itching and leaking pee can disrupt all areas of your life. Emotional side effects are just as complicated as the physical side effects. […] Vaginal atrophy can’t be cured, but you don’t have to live with the discomfort. With proper diagnosis and treatment, the symptoms can be managed. […] Yes, it can. That’s 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.

• #1 Vaginal atrophy | Jean Hailes

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

  Vaginal atrophy is the thinning of your vaginal lining and vulval skin, caused by a drop in oestrogen levels around the time of menopause. […] The vagina, and other tissues in the pelvis, need oestrogen to stay healthy. When oestrogen levels drop (around the time of menopause), the tissues become drier, thinner and more fragile. This can increase the risk of irritation and UTIs. […] Vaginal oestrogens are available as tablets, pessaries or creams. They are an effective treatment for vaginal atrophy. They deliver oestrogen directly to the vagina without raising oestrogen levels in the rest of the body. Vaginal oestrogen treatment improves blood flow in the pelvis and increases vaginal secretions. […] 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.

• #1 Diagnosis and Treatment of Atrophic Vaginitis | AAFP

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

  Because the lack of circulating, natural estrogens is the primary cause of atrophic vaginitis, hormone replacement therapy is the most logical choice of treatment and has proved to be effective in the restoration of anatomy and the resolution of symptoms. Estrogen replacement restores normal pH levels and thickens and revascularizes the epithelium. Adequate estrogen replacement therapy increases the number of superficial cells. Estrogen therapy may alleviate existing symptoms or even prevent development of urogenital symptoms if initiated at the time of menopause.

• #1 Hormonal treatment of vulvar vaginal atrophy (VVA): Are there options to reduce or avoid systemic adverse effects and risks?

  https://www.oatext.com/hormonal-treatment-of-vulvar-vaginal-atrophy-vva-are-there-options-to-reduce-or-avoid-systemic-adverse-effects-and-risks.php

  Vulvar and vaginal atrophy (VVA) are mainly caused by the decrease of estrogen production during peri- and postmenopause. […] The mechanisms of estrogens in treating and reversing the physiological changes associated with VVA may include promoting vaginal cell growth and cellular maturation, enhancing vaginal blood flow, fostering lactobacilli recolonization, decreasing vaginal pH, and increasing vaginal epithelial thickness and elasticity. […] Ospemifene has been primarily developed as a SERM which despite oral application should selectively act as estrogen agonist in the vaginal tissue. […] The question if the use of ospemifene may avoid adverse systemic effects will be discussed in context with a study, which in details already has been published as an original paper together with the corresponding author of the present review.

• #1 Genitourinary syndrome of menopause

  https://www.racgp.org.au/afp/2017/july/genitourinary-syndrome-of-menopause

  Oestrogen vaginal preparations reduce symptoms and reverse the atrophic changes in pelvic tissues, and improve blood flow and the thickness of the epithelium in the vagina, bladder and urethra. There is minimal systemic absorption, with an initial peak, then almost no further absorption. Vaginal oestriol preparations of cream and pessaries provide a human oestrogen. Oestriol is the weakest oestrogen and has one-tenth of the potency of oestradiol. There is minimal absorption systemically and oestriol cannot be metabolised to oestradiol or oestrone. Low-dose vaginal oestradiol tablets are also very effective in relieving atrophic symptoms. The individual dose is 10 g, and studies have found that the annual absorption of oestradiol is only 1.14 mg. […] GSM is a chronic complex syndrome of multiple changes in the genitourinary tissues in response to the loss of oestrogen with menopause. The experience of atrophic symptoms varies and ranges from mild to debilitating, with effects on genitourinary function, sexual function, relationships and quality of life.

• #1 Vaginal Atrophy – MD Searchlight

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

  Vaginal atrophy is a condition that can affect women at any stage, but it is more common among women after menopause. […] The significant drop in estrogen production triggered by menopause, which can be as much as 95%, often leads to this condition. […] 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 dont manage the symptoms effectively, hormone therapy might be necessary. This could include systemic hormonal replacement therapy (HRT), which involves oral estrogen replacement, or localized HRT, which could be topical estrogen, a vaginal ring that releases estrogen, or vaginal application of dehydroepiandrosterone (DHEA, a male hormone). Studies suggest that around 75% of cases improve with systemic HRT, while local therapy is effective in 80%-90% of cases. Local therapy is generally viewed as safer than systemic.

• #1 Recent Research on the Treatment of Vulvar and Vaginal Atrophy

  https://www.imrpress.com/journal/CEOG/49/12/10.31083/j.ceog4912265/htm

  Over the last years, fractional CO2 laser therapy has been an emerging, effective, and safe choice for women affected by VVA. Several studies confirm the efficacy and safety of CO2 laser treatment with its improvements to blood flow in vaginal epithelium, muscle and collagen tone, and elasticity of the vaginal wall, and findings similar to a premenopausal state, restoring vaginal flora to premenopausal status with predominant lactobacilli. […] For postmenopausal women under anti-estrogen therapy, the LAAVA pilot study showed a significant efficacy of three CO2 laser sessions on symptoms of VVA, such as dryness, itch, burning, dysuria, and dyspareunia. […] Signs and symptoms of VVA are very common between menopausal women, worsening their QoL and sexual health; the choice of a therapy depends on a variety of factors, such as patient preference and treatment effectiveness and safety. It is critical to act expeditiously and to adapt the personalized treatment to each woman, considering not only medical history, but anxieties and fears typical of this delicate stage of life.

• #1 Histological Modifications of Postmenopausal Vaginal Mucosa after Regenerative Solid State Laser Treatment: A Multicenter Study

  https://clinmedjournals.org/articles/ijwhw/international-journal-of-womens-health-and-wellness-ijwhw-5-099.php?jid=ijwhw

  After four laser treatments (T4), study protocol complete, new biopsies were taken and the new vulvo-vaginal samples show almost a restauration to „normal” epithelium or, more correctly, to a pre-menopausal histological condition. […] The other key point of this study is the histological demonstration of inflammatory reduction: Comparing the tissues collected at T4 with T0 there is a decreasing in the lymphocytic and, in general in all inflammatory infiltrate of derma and chorion, almost none in T4, ending in a restitution ad-integrum also from an inflammation point of view. […] This is probably one of the main point acting in the GSM symptoms reduction. […] Improvement in histological features was demonstrated after SSVL comparing tissue samples collected before and after treatment and at the same time an amelioration was observed on VHIS, VVA symptoms and sexual female function.

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

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

  Despite VVA being a common side effect, affecting 19–91% of patients treated for oncogynecological conditions, surveys indicate that only about half of oncologists discuss this complication before treatment, and 65–85% report lacking sufficient knowledge about VVA treatment options. […] Common treatments for VVA include vaginal lubricants and moisturizers, vaginal dilators, pelvic floor exercises, local estrogen and dehydroepiandrosterone, systemic hormone therapy, or ospemifene. […] A clear understanding of treatment safety and efficacy in this patient group is vital for healthcare providers to choose the best approach, as some patients prefer other modalities over standard local therapies, improving adherence and outcomes. […] VVA is a significant issue impacting women’s quality of life broadly. Ignoring symptoms can negatively affect not only patients’ well-being and health but also their sexual life, relationships, self-confidence, and self-esteem. […] Therefore, the aim of this review article is to examine the epidemiology and risk factors, diagnosis, and management of VVA following the treatment of gynecologic oncology disorders.

• #1 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. Urinary frequency and recurrent bladder infections may also occur. […] 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. The spectrum of adverse consequences makes long-term treatment essential in many patients, not only for relief of symptoms and improved quality of life, but also for the more troublesome problems that may occur, such as sexual dysfunction, postcoital bleeding, and recurrent urinary tract infections. Treatment options include both hormonal and nonhormonal interventions.

• #1 Tissue changes associated with vaginal atrophy – Clinical Advisor

  https://www.clinicaladvisor.com/features/tissue-changes-associated-with-vaginal-atrophy/

  In the vaginal tissues, loss of collagen, adipose tissue, and the ability to retain water are common with estrogen deficiency, resulting in thinning of the epithelial surface. […] At the cytologic level, fewer superficial epithelial cells are observed, but an increased percentage of intermediate and parabasal cells are found as a result of estrogen deficiency. […] The incidence of epithelial thinning caused by lower estrogen levels during menopause results in decreased availability of glycogen-rich cells. […] Estrogen deficiency also interferes with many physiologic responses associated with sexual arousal, including smooth muscle relaxation, vasocongestion, and vaginal lubrication. […] Decreased blood flow to the urogenital tissues is associated with atrophy of the lamina propria blood vessels, contributing to vaginal dryness and reduced tissue elasticity, which can lead to painful, unpleasant, and unsatisfactory intercourse, or dyspareunia.

• #1 Tissue changes associated with vaginal atrophy – Clinical Advisor

  https://www.clinicaladvisor.com/features/tissue-changes-associated-with-vaginal-atrophy/

  Vaginal atrophy is a collection of symptoms including vaginal dryness, dysuria, and vulvovaginal irritation and itching that are generally associated with declining estrogen levels attributable to menopause. […] The occurrence of vaginal atrophy during menopause is associated with declining estrogen levels that cause structural and functional changes in vaginal tissue, including atrophy of vaginal tissue, an upward shift in vaginal pH, decreased blood flow to tissues, shortening and narrowing of the vagina, and reduced vestibular sensation. […] This loss of vaginal estrogen production during menopause plays a major role in the development of various physiologic changes associated with vaginal atrophy. […] Decreased availability of circulating estrogen results in the shortening and narrowing of the vagina, with a loss of elasticity and rugal folds leading to smoother epithelial surfaces.

• #2 Genitourinary syndrome of menopause (vulvovaginal atrophy): Clinical manifestations and diagnosis – UpToDate

  https://www.uptodate.com/contents/genitourinary-syndrome-of-menopause-vulvovaginal-atrophy-clinical-manifestations-and-diagnosis

  Genitourinary syndrome of menopause (GSM, previously referred to as vaginal atrophy, vulvovaginal atrophy, urogenital atrophy, or atrophic vaginitis) is defined as a collection of symptoms and signs caused by hypoestrogenic changes to the labia majora/minora, clitoris, vestibule/introitus, vagina, urethra, and bladder that occur in menopausal patients. […] Although vaginal atrophy typically occurs in menopausal patients, it can occur in females of any age who experience a decrease in estrogenic stimulation of the urogenital tissues. […] Not all patients with atrophic changes on examination are symptomatic.

• #2 Vulvovaginal Atrophy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2800285/

  Vulvovaginal atrophy (VVA) is a common and underreported condition associated with decreased estrogenization of the vaginal tissue. […] Vulvovaginal atrophy occurs under conditions of hypoestrogenism. […] The vaginal epithelium is a stratified squamous epithelium, which until menopause is moist and thick with rugae. At menopause, with declining levels of estrogen, the vaginal epithelium thins. […] A decline in estrogen level causes a decrease in vaginal blood flow and a decrease in vaginal lubrication. […] The effects of endogenous estrogens on vulvovaginal tissues are mediated through estrogen receptors (ERs) and , found at sites throughout the urogenital area, including the vagina, vulva, labia, urethra, and bladder trigone.

• #2 Genitourinary Syndrome of Menopause | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/30935

  Estrogen plays a crucial role in maintaining the normal anatomy and physiology of the urogenital system. Estrogen receptors are present in the vagina, vulva, urethra, and bladder trigone, where they respond to estrogen stimulation by maintaining normal blood flow, tissue thickness, rugosity, elasticity, and moisture of epithelial surfaces. […] After menopause, the quantity of lactobacilli decreases, leading to an increase in the vaginal pH and the development of GSM. […] A decline in estrogen levels during menopause causes urogenital atrophy. As estrogen production decreases, secretions diminish, and the genitourinary tissues become atrophic, leading to the symptoms associated with GSM. […] Estrogen plays a critical role in maintaining healthy blood flow and a balanced microbiome in the vagina while maintaining the elasticity, thickness, and moisture of the vaginal epithelium by sustaining collagen levels. Estrogen also promotes the exfoliation of vaginal epithelial cells, leading to increased glycogen levels, which lactobacilli in the normal vaginal flora convert into lactic acid. This process allows for the renewal of the vaginal epithelium and maintains the vagina’s typical acidic pH. When estrogen levels decline, this process is disrupted, resulting in an atrophic vaginal epithelium with reduced secretions and a less acidic environment characterized by a pH greater than 5.

• #2 Atrophic vaginitis – Wikipedia

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

  Atrophic vaginitis is inflammation of the vagina as a result of tissue thinning due to low estrogen levels. […] The decrease in estrogen typically occurs following menopause. […] Atrophic vaginitis may be caused by tissue thinning, loss of elasticity, and loss of vaginal fluids from low estrogen levels. […] When estrogen levels drop, this process slows down, leading to thinner vaginal tissue, less moisture, and a less acidic environment. […] Estrogen is crucial for women’s sexual and urinary health. […] All tissue types such as connective, epithelial, muscular, blood vessels, and nerves are affected and become thinner and less effective, which increases risk of infections, inflammation, injuries, and sores. […] Antiestrogen medications may also contribute to the development of atrophic vaginitis.

• #2 Genitourinary syndrome of menopause

  https://www.racgp.org.au/afp/2017/july/genitourinary-syndrome-of-menopause

  Genitourinary syndrome of menopause (GSM) is a more accurate and inclusive term that describes the multiple changes occurring in the external genitalia, pelvic floor tissues, bladder and urethra, and the sexual sequelae of loss of sexual function and libido, caused by hypoestrogenism during the menopause transition and postmenopause. These genitourinary changes primarily occur in response to reduced oestrogen levels and ageing, and do not settle with time. […] The loss of oestrogen causes anatomical and functional changes, leading to physical symptoms in all of the genitourinary tissues. The tissues lose collagen and elastin; have altered smooth muscle cell function; have a reduction in the number of blood vessels and increased connective tissue, leading to thinning of the epithelium; diminished blood flow; and reduced elasticity. Thinning is also related to the change in the vaginal epithelial cells. Premenopausally, the predominant cells are intermediate and superficial, and there are few parabasal cells, whereas after menopause, the number of parabasal cells increase, and sometimes there is an increase in intermediate cells and loss of superficial cells.

• #2 Pathophysiology of VVA – Flynn Forum

  https://flynnforum.com/womens-health/pathophysiology-of-vva/

  Vulvar and vaginal atrophy (VVA) is a relatively common condition symptomatically affecting approximately 50% of all postmenopausal women. Under hypoestrogenic conditions, the vaginal epithelium becomes thinner, its barrier function is lost, the vaginal folding decreases, the elasticity of the tissues decreases, and the secretory activity of the Bartholin glands decreases, which lead to traumatisation of the vaginal mucosa and painful sensations. These changes in vaginal epithelium also cause changes in the vaginal microbiota, resulting in increased urinary tract infections. Recurrent urinary tract infections occur in up to 20% of postmenopausal women because of atrophy of the urothelium in response to estrogen deficiency. Clinical findings include atrophy of the labia majora and vaginal introitus. The labia minora may recede. Vulvar and vaginal mucosae may appear pale, shiny, and dry; if there is inflammation, they may appear reddened or pale with petechiae. Vaginal rugae disappear, and the cervix may become flush with the vaginal wall. Vaginal shortening and narrowing tend to occur.

• #2 Tissue changes associated with vaginal atrophy – Clinical Advisor

  https://www.clinicaladvisor.com/features/tissue-changes-associated-with-vaginal-atrophy/

  Vaginal atrophy is a collection of symptoms including vaginal dryness, dysuria, and vulvovaginal irritation and itching that are generally associated with declining estrogen levels attributable to menopause. […] The occurrence of vaginal atrophy during menopause is associated with declining estrogen levels that cause structural and functional changes in vaginal tissue, including atrophy of vaginal tissue, an upward shift in vaginal pH, decreased blood flow to tissues, shortening and narrowing of the vagina, and reduced vestibular sensation. […] This loss of vaginal estrogen production during menopause plays a major role in the development of various physiologic changes associated with vaginal atrophy. […] Decreased availability of circulating estrogen results in the shortening and narrowing of the vagina, with a loss of elasticity and rugal folds leading to smoother epithelial surfaces.

• #2 Tissue changes associated with vaginal atrophy – Clinical Advisor

  https://www.clinicaladvisor.com/features/tissue-changes-associated-with-vaginal-atrophy/

  In the vaginal tissues, loss of collagen, adipose tissue, and the ability to retain water are common with estrogen deficiency, resulting in thinning of the epithelial surface. […] At the cytologic level, fewer superficial epithelial cells are observed, but an increased percentage of intermediate and parabasal cells are found as a result of estrogen deficiency. […] The incidence of epithelial thinning caused by lower estrogen levels during menopause results in decreased availability of glycogen-rich cells. […] Estrogen deficiency also interferes with many physiologic responses associated with sexual arousal, including smooth muscle relaxation, vasocongestion, and vaginal lubrication. […] Decreased blood flow to the urogenital tissues is associated with atrophy of the lamina propria blood vessels, contributing to vaginal dryness and reduced tissue elasticity, which can lead to painful, unpleasant, and unsatisfactory intercourse, or dyspareunia.

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

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

  In addition, under conditions of estrogen deficiency, the balance of the vaginal microbiota is disrupted, the pathogenic gram-negative fecal flora and other bacteria prevail in its composition, and the vagina develops a less acidic pH, that is, from 5.5 to 6.8. […] The main therapeutic goal in managing VVA is to relieve symptoms and restore the vaginal environment to a healthy premenopausal state. […] Considering the cause (hypoestrogenism), and the pathogenesis of the development of VVA, the most logical choice for the treatment of this condition would be estrogen therapy. […] Replenishment of estrogen deficiency can be carried out with hormonal preparations with systemic and local action, as well as with preparations of plant origin. […] Studies have shown that systemic HRT eliminates the symptoms of vaginal atrophy in 75% of cases, while local therapy does so in 80%90% of cases.

• #2 Complications of Vaginal Atrophy: WHASN Sunset Valley: Obstetrics & Gynecology

  https://www.whasnsunsetvalley.com/blog/complications-of-vaginal-atrophy

  Vaginal atrophy, also known as atrophic vaginitis, refers to a thinning of the vaginal walls which can cause dryness, irritation, and increased infection risk. […] A drop in hormones causes many women to experience vaginal atrophy after menopause. […] The thinning and inflammation associated with vaginal atrophy is due to a severe reduction of estrogen. […] Vaginal atrophy caused by a drop in hormones can also affect the acidic environment in your vagina. This acidic environment keeps your vagina healthy, so a change in your pH balance can lead to an increase in bacterial and yeast infections. […] Vaginal atrophy can eventually also lead to urinary system atrophy which can cause burning and painful urination, as well as urgent urination.

• #2 Vaginal atrophy – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288

  Vaginal atrophy (atrophic vaginitis) is thinning, drying and inflammation of the vaginal walls that may occur when your body has less estrogen. Vaginal atrophy occurs most often after menopause. […] Genitourinary syndrome of menopause is caused by a decrease in estrogen production. Less estrogen makes your vaginal tissues thinner, drier, less elastic and more fragile. […] A drop in estrogen levels may occur: After menopause, During the years leading up to menopause (perimenopause), After surgical removal of both ovaries (surgical menopause), During breast-feeding, While taking medications that can affect estrogen levels, such as some birth control pills, After pelvic radiation therapy for cancer, After chemotherapy for cancer, As a side effect of breast cancer hormonal treatment. […] Although the condition is common, not all menopausal women experience GSM. Regular sexual activity, with or without a partner, can help you maintain healthy vaginal tissues.

• #2 Vaginal atrophy // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/vaginal-atrophy

  Vaginal atrophy (atrophic vaginitis) is thinning, drying and inflammation of the vaginal walls that may occur when your body has less estrogen. Vaginal atrophy occurs most often after menopause. […] Genitourinary syndrome of menopause is caused by a decrease in estrogen production. Less estrogen makes your vaginal tissues thinner, drier, less elastic and more fragile. […] A drop in estrogen levels may occur: After menopause, During the years leading up to menopause (perimenopause), After surgical removal of both ovaries (surgical menopause), During breast-feeding, While taking medications that can affect estrogen levels, such as some birth control pills, After pelvic radiation therapy for cancer, After chemotherapy for cancer, As a side effect of breast cancer hormonal treatment. […] Typically, the vaginal lining consists of healthy tissues that are several layers thick and naturally moist. A dry vaginal lining becomes thinner and loses natural moisture.

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

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

  Atrophic vaginitis, also known as vaginal atrophy, is when the tissues of the vaginal canal become thinner, often leading to dryness and inflammation. The condition occurs most commonly in people experiencing perimenopause or menopause due to the drop in estrogen that happens during menopause. […] Vaginal atrophy is caused by a drop in estrogen, which typically occurs in people who are going through or have completed menopause. Menopause, which is when you stop having menstrual periods, causes a 95% drop in estrogen production. Estrogen is responsible for maintaining vaginal physiology, including tissue strength, suppleness, and blood flow to the vagina. As estrogen drops, the vaginal walls become thinner, and vaginal lubrication decreases. […] Although vaginal atrophy happens most widely in people of menopausal age (around age 45-55), it can occur in people who have experienced early menopause, gone through cancer treatment, or had their ovaries removed. Other risk factors for vaginal atrophy include primary ovarian insufficiency (when the ovaries start to fail before age 40), ovarian failure, pituitary or thyroid disorders, and anti-estrogen medications. After childbirth and during breastfeeding, there is also a steep drop in estrogen, which can cause symptoms of vaginal atrophy or dryness for some people.

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

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

  Vulvovaginal atrophy, characterized by the thinning of vaginal mucosa typically resulting from reduced estrogen levels, is frequently exacerbated by oncogynecologic treatments such as chemotherapy, hormonal therapy, radiotherapy, or surgery. […] Patients with oncogynecologic diseases undergoing hormonal therapy, systemic chemotherapy, radiotherapy, or surgery experience ovarian damage or removal, leading to estrogen deficiency and the onset or worsening of VVA symptoms. […] AIs inhibit estrogen production, while TX’s metabolite, endoxifen, acts as an estrogen receptor antagonist but stimulates alpha estrogen receptors in the vagina, potentially increasing secretions and reducing VVA risk. […] Radiotherapy (RT) is employed in the treatment of cervical, endometrial, and vaginal cancer. RT not only has gonadotoxic effects but also disrupts vaginal tissue vascularization and innervation, leading to fibrosis.

• #2 Vaginal Atrophy

  https://comprehensive-urology.com/womens-health/vaginal-atrophy/

  Vaginal atrophy or atrophic vaginitis is the painful inflammation of the vagina as a result of the tissues becoming thin and shrinking, causing decreased lubrication, soreness, and itchiness. The condition is most often caused by a decrease in estrogen, such as after menopause or while breastfeeding. […] The main cause of atrophic vaginitis is a decline in the reproductive hormone estrogen, which results in the vaginal tissues becoming thin, fragile, dry, and less elastic. […] Additional risk factors associated with vaginal atrophy include smoking cigarettes or taking certain medications to decrease estrogen levels or treat endometriosis, breast cancer, fibroids, or infertility, such as Danocrine, Lupron, or Synarel. […] One of the most common and effective treatments for atrophic vaginitis is hormone replacement therapy, which can be administered either topically or orally.

• #2

  https://continentalhospitals.com/diseases/vaginal-atrophy/

  The treatment of vaginal atrophy is a crucial aspect in providing relief and improving the quality of life for women experiencing this condition. […] One commonly recommended treatment for vaginal atrophy is hormone therapy. This involves the use of estrogen, either in the form of creams, tablets, or vaginal rings, to help restore moisture and elasticity to the vaginal tissues. […] Regular sexual activity can help maintain healthy blood flow to the vagina and promote natural lubrication.

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

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

  Local estrogen therapy allows to quickly eliminate the symptoms of VVA, but it does not alleviate the vasomotor symptoms and reduce the risk of osteoporosis. […] The vaginal metabolism of DHEA into estrogens/testosterone leads to the activation of estrogen and androgen receptors in the three layers of the vaginal wall, including the fibers of the basal membrane collagen and the muscle wall, but the absence of aromatase in the normal endometrium does not lead to its stimulation. […] Laser therapy improves the vascularization of the vaginal mucosa, stimulates the synthesis of new collagen and matrix basic substance in the connective tissue, thickens the vaginal epithelium with the formation of new papillae, replenishes glycogen in the vaginal epithelium, allows restoring the balance of the mucosa and therefore improves the symptoms of atrophy caused by a lack of estrogen. […] Timely active detection of this pathological condition and providing adequately selected therapy can prevent the progress of the disease and significantly improve the quality of life and sexuality of women.

• #2 Vaginal Atrophy – MD Searchlight

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

  Vaginal atrophy is a condition that can affect women at any stage, but it is more common among women after menopause. […] The significant drop in estrogen production triggered by menopause, which can be as much as 95%, often leads to this condition. […] 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 dont manage the symptoms effectively, hormone therapy might be necessary. This could include systemic hormonal replacement therapy (HRT), which involves oral estrogen replacement, or localized HRT, which could be topical estrogen, a vaginal ring that releases estrogen, or vaginal application of dehydroepiandrosterone (DHEA, a male hormone). Studies suggest that around 75% of cases improve with systemic HRT, while local therapy is effective in 80%-90% of cases. Local therapy is generally viewed as safer than systemic.

• #2 Vaginal microbiota transplantation alleviates vaginal atrophy in ovariectomized mice | Scientific Reports

  https://www.nature.com/articles/s41598-025-92881-1

  The results showed significant changes in the composition and abundance of the VM and their metabolites after bilateral ovariectomy. […] This suggests that the ovaries can affect VM and metabolites. […] The results showed that both estriol and VMT increased the weight and number of epithelial cell layers in the vagina. […] These findings suggest that both estriol and VMT can effectively alleviate vaginal atrophy. […] The expression of vaginal inflammatory factors was reduced by both estriol and VMT. […] The higher species diversity of VM observed in the OVX group may be attributed to the increased VM richness characteristic of this group. […] The structure of VM in ovariectomized mice was significantly altered by estriol, VMT, and saline irrigation. […] VMT can significantly alter the microbiotas structure. […] This study can well bridge this gap and holds great promise.

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

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

  Vaginal atrophy can affect your quality of life and your relationship with your partner(s). There are physical and emotional side effects of GSM. Physical symptoms like pain, burning, itching and leaking pee can disrupt all areas of your life. Emotional side effects are just as complicated as the physical side effects. […] Vaginal atrophy can’t be cured, but you don’t have to live with the discomfort. With proper diagnosis and treatment, the symptoms can be managed. […] Yes, it can. That’s 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.

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

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

  Vaginal atrophy is a change of the vagina that develops when there is a significant decrease in levels of the female hormone estrogen. The condition also is called atrophic vaginitis. […] When levels of estrogen are low, vaginal tissue tends to become atrophic thin, dry and shrunken. The vagina is then more prone to inflammation in an atrophic state. […] Estrogen in any form oral, transdermal (via skin patch), or vaginal can help restore normal vaginal pH and beneficial bacteria, thicken the epithelium, increase vaginal secretions, and decrease vaginal dryness. But it’s best to apply the estrogen directly to the vagina. Compared with oral or transdermal estrogen, vaginal application requires a lower dose and involves less exposure of breast and endometrial tissues, where estrogen can increase the risk of cancer by stimulating the growth of cells. Low-dose estrogen products recommended specifically for the treatment of vaginal atrophy include vaginal creams (Estrace and Premarin), the vaginal tablet Vagifem, and Estring (an estradiol-infused silicone ring that sits around the cervix and releases a very low, steady dose of estrogen).

• #2 Prasterone (Intrarosa) for Dyspareunia | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0115/p117.html

  Prasterone (Intrarosa) is an intravaginal product used to treat moderate to severe dyspareunia due to vulvar and vaginal atrophy caused by menopause. The mechanism of action of intravaginal prasterone is not known, but it may involve local metabolism to estrogens and androgens. […] Prasterone has not been shown to increase serum steroid concentrations, nor has it been linked to the development of endometrial hyperplasia or endometrial cancer. […] Prasterone is similarly effective to nonprescription options for treating vaginal dryness and itching associated with menopause and may offer a small benefit in the treatment of dyspareunia. Intravaginal prasterone may have a slight effect on increasing sexual desire and sexual arousal compared with a vaginal lubricant, but it is not labeled for this use.

• #2 Hormonal treatment of vulvar vaginal atrophy (VVA): Are there options to reduce or avoid systemic adverse effects and risks?

  https://www.oatext.com/hormonal-treatment-of-vulvar-vaginal-atrophy-vva-are-there-options-to-reduce-or-avoid-systemic-adverse-effects-and-risks.php

  From the above results of one special trial, described as an example within the extensive research during the development of ospemifene, we can conclude that during treatment with ospemifene systemic adverse events, including endometrium-proliferating effects, are very rare but should not be excluded. […] Using ospemifene, the labeling of the commercial product includes warnings which seem to compare with the risks observed with estrogens (endometrial cancer, venous thrombosis and stroke), perhaps because systemic effects of ospemifene cannot be excluded and because these risks have been seen with other SERMs.

• #2 Histological Modifications of Postmenopausal Vaginal Mucosa after Regenerative Solid State Laser Treatment: A Multicenter Study

  https://clinmedjournals.org/articles/ijwhw/international-journal-of-womens-health-and-wellness-ijwhw-5-099.php?jid=ijwhw

  The main contribution of this study is the use of a new type of laser, the Solid State Vaginal Laser (SSVL). […] In this study we demonstrated that, after four laser treatments, histological modifications are present and deep enough to be interpreted as tissue remodeling in a rejuvenating sense. […] The other key point is the demonstration of inflammatory tissue reduction: Comparing samples collected before and after treatment a decreasing in the lymphocytic and, in general in all inflammatory infiltrate of derma and chorion, can be observed and this infiltrate is almost absent after the last laser session, meaning a restitution ad integrum not only from an histological but also from an inflammation point of view.

• #2 Vaginal atrophy: causes, symptoms and treatment | SEID Lab

  https://lab-seid.com/vaginal-atrophy-understanding-a-common-condition-in-women/?lang=en

  Vaginal atrophy can have a very significant impact on the quality of life of those who experience it. […] The symptoms associated with this condition can vary in intensity, but generally affect sexual comfort and well-being, as well as the overall health of the intimate area. […] Vaginal dryness is one of the most common symptoms of vaginal atrophy. Due to decreased oestrogen levels, vaginal tissue becomes thinner and less lubricated, which can cause discomfort and pain during intercourse. […] Pain or discomfort during sexual intercourse is known as dyspareunia. As a result of atrophic vaginitis, the tissues become more fragile and lose elasticity, making penetration difficult and causing pain or uncomfortable sensations during intercourse. […] Vaginal atrophy increases the risk of urinary tract infections, as reduced oestrogen can disrupt the balance of beneficial bacteria in the vaginal area.

• #2 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. Vaginal atrophy develops secondary to a lack of estrogen due to menopause. […] Atrophic vaginal changes are caused by thinning vaginal epithelium, decreased vaginal rugae and elasticity, and decreased vaginal secretions. Atrophic vaginitis is a symptomatic inflammatory process involving the thinned vaginal epithelium affecting some pre-menopausal and up to 50% of post-menopausal women. […] The hypoestrogenic state results in the fusion of collagen fibers and fragmentation of elastin fibers in vulvovaginal tissue and decreased squamous cells, resulting in decreased mucosal elasticity and decreased rugae, and narrowing of the vagina. […] The consequence of elevated vaginal pH is a shift in normal flora, Lactobacilli spp., and more susceptible to other pathogens such as Gardnerella, Prevoltella, Atopobium, and Streptococcus.

• #2 Atrophic Vaginitis

  https://mobile.fpnotebook.com/Gyn/Vagina/AtrphcVgnts.htm

  Related to decreased Estrogen with Menopause […] Vaginal epithelium thins with decreased lubrication […] Vaginal canal narrowing […] Glycogen loss with altered Vaginal pH and flora.

• #2 Vaginal atrophy: causes, symptoms and treatment | SEID Lab

  https://lab-seid.com/vaginal-atrophy-understanding-a-common-condition-in-women/?lang=en

  Various treatments are available to address the symptoms of vaginal atrophy and improve the quality of life of affected women. […] Hormone replacement therapy (HRT) involves the administration of hormones, such as oestrogen, to compensate for the natural decrease in hormone levels in the body. It can help restore vaginal health, relieve dryness and improve tissue elasticity. […] Each woman requires a personalised approach to relieve the symptoms of vaginal atrophy and improve her quality of life.

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

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

  Postmenopausal atrophic vaginitis, or vaginal atrophy, is the thinning of the walls of the vagina caused by decreased estrogen levels. This most commonly occurs after menopause. […] The cause of atrophic vaginitis is a decline in estrogen. Without estrogen, vaginal tissue thins and dries out. It becomes less elastic, more fragile, and more easily injured. […] Atrophic vaginitis increases a womans risk of contracting vaginal infections. Atrophy causes changes in the acidic environment of the vagina, making it easier for bacteria, yeast, and other organisms to thrive. […] With treatment, its possible to improve your vaginal health and your quality of life. Treatment can focus on symptoms or the underlying cause. […] Estrogen improves vaginal elasticity and natural moisture. It usually works in just a few weeks. Estrogen can be taken either topically or orally.

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

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

  With the gradual loss of serum estrogen as women age, the epithelium of the vulva and vagina undergo atrophy (thinning of the tissue). In post-menopausal women, this is responsible for many of the symptoms of Genitourinary Syndrome of Menopause (GSM). […] The cause of atrophic vulvovaginal symptoms (GSM) is loss of estrogen resulting from menopause, castration, anti-estrogens (tamoxifen), or ovarian destruction. […] Natural menopause is the most common cause of vulvovaginal atrophy. With a thin, atrophic, vaginal epithelium, there is a shift in vaginal pH with values from >4.5 up to 7, and a shift in the vaginal maturation index from the superficial epithelial cells and robust lactobacilli of premenopause, to a preponderance of parabasal cells and absence of lactobacilli. […] Diagnosis is made clinically based on history, physical exam, and use of the maturation index via vaginal pH and wet prep with microscopy.

• #3 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. Vaginal atrophy develops secondary to a lack of estrogen due to menopause. […] Atrophic vaginal changes are caused by thinning vaginal epithelium, decreased vaginal rugae and elasticity, and decreased vaginal secretions. Atrophic vaginitis is a symptomatic inflammatory process involving the thinned vaginal epithelium affecting some pre-menopausal and up to 50% of post-menopausal women. […] The hypoestrogenic state results in the fusion of collagen fibers and fragmentation of elastin fibers in vulvovaginal tissue and decreased squamous cells, resulting in decreased mucosal elasticity and decreased rugae, and narrowing of the vagina. […] The consequence of elevated vaginal pH is a shift in normal flora, Lactobacilli spp., and more susceptible to other pathogens such as Gardnerella, Prevoltella, Atopobium, and Streptococcus.

• #3 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. Hormonal changes, especially hypoestrogenism inherent in menopause, are characterized by a variety of symptoms. […] VVA is just a component of this general condition. Characterized by a chronic progressive course, VVA significantly impairs the quality of life and sexual health of women. […] As the estrogen deficiency grows, dystrophic and atrophic changes develop in the vaginal mucosa, vulva, and other structures of the urogenital tract. […] Under hypoestrogenic conditions, the vaginal epithelium becomes thinner, its barrier function is lost, the vaginal folding decreases, the elasticity of the tissues decreases, and the secretory activity of the Bartholin glands decreases, which lead to traumatization of the vaginal mucosa and painful sensations.

• #3 Osphena® Mechanism of Action video – Osphena HCP

  https://hcp.osphena.com/osphena-mechanism-of-action-video

  OSPHENA (ospemifene) is indicated for: […] The treatment of moderate to severe dyspareunia, a symptom of vulvar and vaginal atrophy, due to menopause. […] The treatment of moderate to severe vaginal dryness, a symptom of vulvar and vaginal atrophy, due to menopause. […] OSPHENA is an estrogen agonist/antagonist with tissue selective effects. In the endometrium, OSPHENA has estrogen agonistic effects. There is an increased risk of endometrial cancer in a woman with a uterus who uses unopposed estrogens. […] An increased risk of endometrial cancer has been reported with the use of unopposed estrogen therapy in a woman with a uterus. The greatest risk appears to be associated with prolonged use and estrogen dose.

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