Vulvovaginal Atrophy and Menopause

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Vulvovaginal Atrophy: Symptoms & Management

Imagine experiencing persistent discomfort, itching, vaginal dryness, and even pain during intimate moments with your partner. For millions of women, these symptoms aren’t just a hypothetical scenario—they’re the reality of living with vaginal atrophy. These common menopause-related symptoms and conditions can disrupt lives and relationships, yet many women are unaware of the treatment options available to them. I will explore the causes, symptoms, and management strategies for vulvovaginal issues, empowering you to take control of your vaginal health and improve your quality of life.

Hey there, I’m not sporting a doctor’s coat or wielding a stethoscope—just a friendly reminder that I’m not your go-to for medical advice! For the ultimate health scoop, chat it up with your doctor; they’re the real MVPs.

Now, buckle up for this post – it’s like a rollercoaster for your brain, providing tidbits to spark your curiosity. Ready, set, research!.

What is vaginal Atrophy?

Declining estrogen levels cause genitourinary syndrome (also known as vaginal atrophy). This can cause the vaginal wall tissues to thin, become dry, and inflamed, leading to irritation, soreness, or even vaginal discharge. Sufferers may also experience painful sexual intercourse (dyspareunia).

Vaginal Atrophy is prevalent in premenopausal, menopausal, postmenopausal women and women who have gone through cancer and or cancer treatments.

Identifying Symptoms of Vaginal Atrophy

The symptoms could involve physical changes such as modifications in vaginal tissue texture or shape, along with urinary problems arising from an effect on the bladder and urethra.

Additional symptoms may include decreased secretions from the cervix and visible ulcerations, telangiectases, vaginal dryness, ecchymoses, and fissures on a mucosal surface that appear thinner than usual. Furthermore, signs of deterioration, such as a diminished rugae structure, may be observed in the labia and vulva.

So, you must get checked by a doctor! Once appropriately diagnosed, you can choose the best treatment for your issues.

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Diagnosis and Testing for Vaginal Atrophy

You will need to do physical exams, assessments and tests such as vaginal pH or VMI (vaginal maturation index)- check the list below.

  • A thorough exam of the vagina, cervix, and external genitalia.

  • Vaginal pH Testing to obtain the VMI score.

  • Pelvic exam.

  • Urine culture for UTI.

  • Serum hormone level tests.

  • Papnicolaou test.

  • Ultrasound.

  • Infection test.

Why is Estrogen so Important?

Estrogen regulates the menstrual cycle; it maintains your breasts, your bones, and your heart healthy. Estrogen is crucial in keeping your vagina healthy by maintaining the vagina walls thick and keeping the vagina properly moisturized. Estrogen is crucial for the well-being of a woman, so when it declines due to an illness or menopause, it creates a bit of havoc in women’s lives. It did in mine!

What happens if I don’t have enough estrogen levels in my body?

  • Vaginal atrophy

  • Bone loss/ brittle bones

  • Feeling tired

  • Insomnia

  • Vaginal dryness

  • Vaginal infections

  • Thin vaginal walls (causes painful intercourse)

  • Urinary tract infections

  • Vaginal discharge

  • Hot flashes

  • Low sexual desires

And more!

Breast Cancer, Menopause, and, Vaginal Atrophy Symptoms

If you underwent treatment for breast cancer during menopause or post-menopause, your estrogen levels may have decreased. This decrease in estrogen can also contribute to the development of vaginal atrophy and vaginal dryness. Both sufferers of the genitourinary syndrome and post-breast cancer patients must understand what they’re dealing with so they get proper treatment.

Chances are that you will not be able to do hormone therapy and will need to go another route. Explore alternative options cautiously, but always chat with your doctor before introducing anything new, especially if you have to deal with cancer. Some medications do not mix well with alternative meds and treatments.

Vaginal Atrophy and Menopause

The connection between menopause and vulvovaginal atrophy is essential to recognize for adequate care and treatment. Some women can benefit from a range of treatment options for vaginal atrophy, such as vaginally administered local estrogens, oral hormone therapy like estradiol vaginal tablets, low dose vaginal estrogen creams. These hormone treatments are done to maintain a balanced combination of internal (endogenous) and external (exogenous) vaginal estrogens. If you decide to undergo hormone replacement treatment, your doctor will conduct tests before and during your treatment. It’s important to note that estrogen isn’t a one-size-fits-all solution. If you’re dealing with conditions like cancer or other health issues, your doctor might advise against hormone use.

If you cannot do an estrogen therapy treatment, you can use nonhormonal vaginal moisturizers, vaginal lubricants, and products.

Nonhormonal Vaginal Treatments

  • Non-estrogen moisturizers help vaginal lubrication.

  • Water-based vaginal lubricant for vaginal dryness.

  • Natural oils such as coconut oil (with NO perfume!) can help, but conclusive tests have yet to be conducted.

  • Local vaginal estrogen therapy may be acceptable for some patients.

  • Vaginal dilators stretch and stimulate vagina muscles while reversing the narrowing of that area.

  • Some have used vaginal laser therapy, but many have complained of chronic pain and burning sensations in the vagina for a long time, so I don’t see that as a great solution!

  • Painful sexual intercourse? Some women have been using Lidocaine along with a vaginal moisturizer. It numbs the nerves during intercourse and still allows for physical feeling.

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Urinary Symptoms

Some urinary issues are related to vaginal atrophy or Genitourinary syndrome. Identifying the signs of urinary tract infections, recurrent urinary tract infections, or other urinary troubles linked to vulvovaginal or vaginal atrophy symptoms is essential for a precise diagnosis and finding the correct fix!

Symptoms can include urgency, frequency of urination, nocturia (needing to go at night), urge incontinence, and recurrent UTIs, which could lead to a more severe case of infection. You may notice a urethral caruncle; this small smooth growth appears soft and crispy at the edge of the urethra due to its thinning from Vulvovaginitis Atrophy.

What is the pelvic floor?

The pelvic floor consists of muscles and ligaments that support the bladder, uterus, and bowel openings. These muscles and ligaments prevent bladder and bowel incontinence and relate to sexual function. Additionally, they contribute to your hips and trunk stability, particularly during walking and standing.

Why is the pelvic floor so important?

It can help you control your urinary incontinence!

How do you find the pelvic muscles?

One effective way to locate your pelvic muscles is during urination. Try stopping the flow of urine by squeezing specific muscles. The muscles you use to stop the flow are your pelvic muscles. Maintaining a healthy pelvic floor is essential for overall well-being. Pelvic floor exercises help strengthen muscles and alleviate symptoms such as urinary incontinence.

What exercises help the pelvic floor’s function?

Do kegels, breathing, squats, and bridges. For best results when you do your Kegels, squeeze the muscles that control the urine and rectum. Pelvic exercises are for women and men.

Note: I have read alot about the pelvic floor lately and learned there are many different exercises that will help you strengthen your pelvic floor. Kegels alone are not enough!

Vaginal Atrophy and Breast Cancer: Special Considerations

When deciding on treatment options for vaginal atrophy in women with a history of breast cancer or women undergoing breast cancer treatment, the potential risks associated with hormone therapy must be taken into account due to breast cancer risk.

You must search for non-hormonal treatments and alternative therapies.

It is important that you do your own research because there are so many options. Unfortunately, there are also so many contradicting opinions! During my research, I found articles suggesting that Ospemifene could be a good option for women who had estrogen-receptive positive breast cancer (which is my case). Many articles state that Opemifene is NOT a good option for estrogen-receptive positive breast cancer. My doctor asked me to stay away from it.

Menopausal and post-menopausal breast cancer survivors and patients need to be extra careful.

Be your best doctor!

Please do your research!

Lifestyle Changes

There are many things you can do to take control of your body and minimize menopausal symptoms, vaginal atrophy, vaginal dryness, and pelvic floor issues.

Learn how to do the exercises to maintain an excellent pelvic floor. Use a good vaginal moisturizer (dosing vaginal creams is important), avoid irritants, and use mild cleansing products. Exercise your body and stay active. Remember the power of water and drink enough water daily. All these practices can help protect the integrity of the vaginal wall.

Sexual Activity

Keeping a regular sexual life can aid in controlling blood flowing to the vagina and strengthening tissue health. Having intimate moments with or without another person is beneficial for women’s vaginal tissues as it helps promote lubrication and increases circulation. Vaginal atrophy can be avoided by leading an active sex lifestyle, which will inevitably lead to healthier overall vaginal tissue well-being. Use good lubricants or vaginal hormonal preparations if your doctor allows it.

Navigating the Emotional Impact of Vaginal Atrophy

The effects of vaginal atrophy on emotional well-being can be severe, leading to reduced self-confidence, difficulties in relationships, and a reduction of general quality of life.

To make things easier, you must get advice from healthcare professionals or seek support groups with similar experiences. Talking to other women will help you understand your issues. Exchange ideas and experiments.

Emotional Challenges

The emotional distress associated with vaginal atrophy can manifest in different forms, such as embarrassment, frustration, and feelings of isolation. These difficulties often lead to reduced self-confidence, distorted body image perception, and disruption in sexual life.


Fueling your body with the right nutrition can be a fantastic boost for replenishing estrogen levels. It’s not a magic pill, but for some folks, even a sprinkle of estrogen from food can make a noticeable difference.

Quick heads-up: If you’ve battled estrogen-related breast cancer treatments, your oncologist might not be thrilled about the notion of introducing any extra estrogen, not even through your meals. So, it’s always wise to check with them first! Boosting your estrogen levels can be as easy as adding plant-powered goodness to your meals! According to UCLA Health, phytochemical-rich plants are the way to go. So, it’s time to explore a little menu and find your estrogen-boosting favorites!

Fruits like apples, berries, and grapes are estrogen champions. Don’t forget the soy squad with soy milk, tofu, miso soup, and miso paste. The veggie and grain team is strong, too—think barley, oats, kale, brussels sprouts, onions, and many more that can be your estrogen allies.

Navigating the world of estrogen-rich foods for your meals can feel like a puzzle, but here’s my secret weapon: weekly soup adventures! Picture this – one week, I whip up a grainy soup base. I add kale, tofu, caramelized onions, and a hint of miso to make that base more exciting. Then, on another day, it’s all about blending the base, carrots, edamame, and spinach into a velvety masterpiece.

Here’s the soup scoop: Get creative with different soup concoctions and enjoy a bowl before every meal. Whether you like hot or chilled, switch the ingredients based on the season. It’s like a culinary journey for your taste buds, and just one or two bowls a day will make you feel fabulous and make your nutrition challenges easy. Soup’s on! ✨

Now, let’s talk about minerals. Boron and vitamins B, D, and E are your go-to team for elevating estrogen levels. But here’s the scoop: annual blood exams are your best friend. You want to keep tabs on those vitamin levels because OD-ing on anything is a no-go. Too much of a good thing can turn not-so-good, so stay savvy!

Be attentive to supplements; don’t take them without speaking to your doctor. I was not allowed to take Black Cohosh and Dong Quai due to my estrogen-receptive positive breast cancer.


Prepare to enhance your well-being with a variety of activities. Introduce some diversity into your weekly routine to combat monotony. Engage in Weight-Bearing Exercises: Embark on a hiking journey or brisk walking session. Incorporate dance moves into your routine or indulge in activities like tennis. The world offers numerous options to keep you physically active.

Build Muscle Strength: Consider incorporating weightlifting or utilizing elastic bands for a resistance workout into your regimen for a satisfying workout. Using your own body as a weight for weight-bearing exercises is challenging and great for your body.

Remember that exercise should be a beneficial and routine part of your life, not a cumbersome task. Head out there and prioritize physical activity to make it an integral aspect of your routine.

cartoon of older woman lifting a weight

My Weekly workouts

I’m on a weight-lifting adventure with my fantastic trainer three times a week. This superhero of a trainer keeps me on my toes because, let’s be real, I have a soft spot for taking it easy on myself. We keep it real and never overdo it, and my age is like our secret code for planning the perfect workout week.

But that’s not all—I’m the wanderer of workouts! I stroll a few times a week, pedal away on my indoor bike (in the comfort of home sweet home), and once a week, I conquer the Sintra hills here in Portugal with a hiking extravaganza. Variety is my middle name, and thanks to my mixed bag of activities, boredom doesn’t stand a chance in my fitness universe! 🏋️‍♀️🚶‍♀️🚴‍♀️🌄

Change your exercise routines to keep them interesting and fresh. Get help from a trainer or use an App to create your weight-lifting exercise routines. Find ways to stay motivated. 🙂


Vulvovaginal atrophy is a condition that affects many postmenopausal women but often goes undiagnosed. Embracing a healthy lifestyle involves seeking medical guidance from healthcare providers and fostering open communication with partners and doctors. This approach can be instrumental in effectively navigating this challenging experience and reclaiming control over vaginal health.

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Updated Feb, 2024

Marguerite Beaty, Blogger, Photographer & Artist

Welcome to the sunny side of life for women over 50! We aim to create a space where women feel empowered, supported, and inspired to lead their best lives after 50. Join our Instagram!

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