Vaginal Atrophy - Diagnosis and Treatment

Diagnosis

Checking the Pelvic Area

Doctors usually check the pelvic organs by gently inserting two gloved fingers into the vagina. At the same time, they press on the abdomen with the other hand to feel the uterus and ovaries.

This method helps spot changes like dryness, thinning, or irritation—very common with vaginal atrophy and low estrogen. They’ll also look for signs of pain, bleeding, or vaginitis.

Treatment

Using Estrogen-Based Vaginal Treatments

Doctors often recommend vaginal estrogen treatments to relieve symptoms like dryness, irritation, and discomfort from lower estrogen after menopause.

By applying estrogen right to the vaginal area, you keep the hormone mostly local, so less goes throughout your whole body. That means fewer side effects compared to pills. Still, you get real relief.

Here are the main forms of vaginal estrogen:

Creams: You use an applicator to put the cream inside the vagina, usually at bedtime. At first, it’s daily, then less often as your doctor suggests.
Suppositories/Tablets: These go inside the vagina with an applicator. How often you use them can change after the first few weeks.
Rings: Flexible rings sit in the upper vagina and slowly release estrogen. You swap them out about every three months.
Low-dose tablets: You use a disposable applicator. You might start with more frequent use, then switch to fewer times per week.

All these options work in pretty similar ways. You and your healthcare provider can decide what fits best—everyone’s got their own preferences, budget, and health needs.

Advantages

Brings targeted relief for dryness and irritation.
Lower chance of hormone absorption through the body than pills.
Plenty of choices for dosing and form.

Points to Consider

Long-term safety for those with a history of breast cancer isn’t fully known yet.
You might notice mild irritation or discharge.
You’ll need a prescription and follow-ups.

Oral Treatment with Osphena

Eelective estrogen receptor modulator (SERM) comes as a prescription pill you take once a day. Doctors use it for people with moderate to severe pain during sex (dyspareunia), often tied to menopausal changes in vaginal tissue.

Ospemifene acts directly on vaginal tissue, making it thicker and less fragile. That helps cut down on discomfort.

Benefits	Points to Consider
• Non-hormonal pill	• Not for those with a history of breast cancer
• Reduces pain during sex	• Can cause hot flashes, discharge, or muscle cramps
• Easy to take	• Needs regular doctor visits and prescriptions

It’s important to talk over risks and benefits with your provider, especially if you have other medical issues.

Nightly Vaginal Inserts: Prasterone

Intravaginal dehydroepiandrosterone (DHEA) is a small insert you place in the vagina each night, usually at bedtime. It delivers DHEA right where it’s needed.

DHEA helps your body make estrogen and other hormones, which can improve vaginal tissue and make sex less painful.

This option works well for women who can’t use direct estrogen products and usually helps with moderate to severe symptoms. Side effects might include discharge or a bit of irritation.

Always talk about any cancer history with your doctor before starting hormone-based treatments.

Estrogen for the Whole Body

Systemic estrogen therapy sends the hormone throughout your whole body, not just the vagina. You might use pills, skin patches, gels, sprays, or higher-dose vaginal rings.

Doctors might suggest this if you’re dealing with both vaginal atrophy and other menopause symptoms like hot flashes or night sweats.

If you still have a uterus, your doctor may add a progestogen to lower the risk of endometrial cancer.

Examples	How Taken
Estrogen pills	Swallowed daily
Skin patches or gels	Worn or applied on the skin
Systemic-dose vaginal ring	Placed in the vagina, replaced regularly

You’ll need regular check-ups because systemic hormone therapy can raise the risk of blood clots, stroke, and some cancers. Definitely discuss all risks and benefits with your doctor before starting.

Nonhormonal Option: Vaginal Stretching Devices

Vaginal dilators are tube-shaped tools that gently stretch the vaginal muscles. You can use them alone or with estrogen therapy.

They help keep the vagina flexible, especially if it’s narrowed from lack of use, menopause, or after cancer treatments.

Using a dilator may reduce discomfort during sex or pelvic exams. Some people also try pelvic floor physical therapy at the same time. A healthcare provider or physical therapist can show you how to use them safely.

Local Pain Relief

Topical local anesthetic is a numbing gel or ointment you put on right before sex or a pelvic exam. It can dull surface pain or irritation in the vaginal area.

Usually, you apply it five to ten minutes before sexual activity. It’s especially helpful if pain makes penetration tough or really uncomfortable.

It doesn’t fix tissue changes, but it can make movement and touch much easier. You’ll need a prescription for lidocaine.

Choosing Safe Care After Breast Cancer

If you’ve had breast cancer—especially hormone-sensitive types—you’ll need to review treatment options closely with both your oncologist and gynecologist.

Treatment Type	Hormone-based?	Example Products	Main Use
Topical vaginal estrogen	Yes (local)	Creams, rings, tablets	Vaginal dryness, irritation
Ospemifene	No (oral SERM)	Osphena	Painful sex
Prasterone	Yes	Intrarosa	Painful sex, vaginal thinning
Systemic estrogen	Yes (whole body)	Pills, patches, gels	Menopausal symptoms plus vaginal atrophy
Vaginal dilators	No	Various brands	Stretching vaginal tissue
Topical lidocaine	No	Prescription ointments	Numbing discomfort for sexual activity
Nonhormonal for breast cancer	No	Moisturizers, dilators	First-line for survivors

Nonhormonal First

Start with vaginal moisturizers and lubricants for dryness and pain.

Vaginal Dilators

Dilators can help as a nonhormonal way to keep tissue flexible.

Low-Dose Vaginal Estrogen

If nonhormonal methods don’t work, your cancer specialists may let you try very low-dose vaginal estrogen.
There’s a possible risk of breast cancer returning with any estrogen use, so you’ll need close medical follow-up.

Avoid Systemic Hormone Therapy

Systemic estrogen therapy usually isn’t recommended for those with hormone-sensitive breast cancer because of higher health risks.

Ways to Care for Yourself

If you’re dealing with vaginal dryness or discomfort, a few simple steps at home might help. Over-the-counter vaginal moisturizers add moisture and keep tissues comfortable.

Many people find water-based lubricants helpful, especially for intimacy and reducing irritation.

Staying relaxed and allowing more time for arousal during sex can boost natural lubrication. Regular self-care may support vaginal health and ease symptoms like dryness or burning.

Self-Care Tips Table

Product Type	Example Purpose
Moisturizer	Daily comfort and moisture
Lubricant	Reduces friction during intimacy

Alternative Options for Treatment

Some people turn to alternative medicine to manage vaginal dryness and discomfort during menopause. You might see individuals trying herbal supplements or therapies like DHEA, which some use for hormone balance.

Treatment Option	Notes
Herbal Supplements	May have side effects or interactions
DHEA	Research is ongoing

Before you try any new supplement or natural therapy, talk with your healthcare provider. Not every option is well-studied, and herbal products aren’t regulated by the FDA like medicines are.

That makes safety and effectiveness a bit of a question mark.

Getting Ready for Your Visit

Steps You Can Take Before Your Appointment

Getting ready for a healthcare visit can make things go more smoothly.

List Your Symptoms: Jot down all the symptoms you’ve noticed—even if they don’t seem related. It helps your doctor get a better picture.
Note Personal Details: Record big life events or changes. Stress or shifts in your routine can affect your health.
Keep Track of Medications: Make a list of everything you take—prescriptions, over-the-counters, herbs, vitamins. Don’t forget the dosages.
Bring Support: Think about bringing a family member or friend. They might remember details or ask questions you forget.
Prepare Questions Ahead of Time: Having specific questions ready helps you use your appointment time well. Here are some ideas:
What could be causing my symptoms?
Are there other possible causes?
Will I need any tests or exams?
Is this problem likely to go away on its own?
What treatment choices do I have?
Do you recommend one treatment over the others?
What other options exist besides your first choice?
How should I manage this with my other illnesses?
Would it help to see a specialist?

Keeping organized notes and bringing your materials helps both you and your provider. Writing down symptoms, meds, and questions ahead of time makes you less likely to forget something important.

Tip: If you tend to forget what was discussed at appointments, bring a small notebook. Jot down answers or instructions while you’re there.

How Your Healthcare Provider Will Guide the Conversation

At the start of your visit, your provider will ask about why you’re there and how your symptoms affect your life. You’ll probably hear questions like:

What kinds of vaginal or urinary symptoms are you having?
How long have these issues bothered you?
Are you still getting your period?
How do these symptoms affect your daily life?
Are you sexually active right now?
Do your symptoms get in the way of sex?
Have you ever had cancer treatment?

Your provider might also ask about your hygiene habits and what products you use. Expect questions such as:

Do you use scented soaps, bubble baths, or sprays like feminine deodorant?
Do you douche?
Have you tried any moisturizers or lubricants from the drugstore?
What medicines, vitamins, or supplements do you take?

They’ll probably want to know about other treatments you’ve tried on your own. If you can be open about what you’ve used—maybe a certain lubricant helped or made things worse—that really helps them recommend what’s best for you.

Example of Questions From the Doctor:

Questions You May Hear	Why They Are Asked
How long have you had these symptoms?	To see if this is a short-term or ongoing issue
Does your condition cause distress?	Understand your personal level of discomfort
Are treatments like lubricants or moisturizers helpful?	To evaluate if non-prescription methods are enough
Any past cancer treatments?	Ensures treatments chosen won’t interfere with others

These questions come up all the time, and being as accurate as you can helps your doctor give you the best care. If you’re not sure about something, just say so. Jotting down notes ahead of time makes it easier to answer.

Helpful Reminders:

Some questions might feel personal, but your provider needs to ask them to get the full picture.
If you don’t understand a question or answer, ask them to explain or repeat it.

If you come prepared, you and your healthcare provider can work together to find the best solutions. Having notes, supporting information, and your own questions can help you feel more confident at your appointment.

Vaginal Atrophy – Diagnosis and Treatment