Atrophic vaginitis

What is atrophic vaginitis?

Atrophic vaginitis is a skin condition of the vulva and vagina. It happens when a hormone called estrogen is low or lacking in the body. You can get it at any age but not all women get it.

It is often found in women who are menopausal (women whose ovaries have stopped making estrogen).

It can also be seen in women who:

  • Are breastfeeding
  • Using Depo-medroxyprogesterone (Depo-ProveraTM)
  • Tamoxifen (NolvadexTM), Letrozole (FemaraTM)
  • Have had their ovaries surgically removed

Lowering estrogen levels can cause skin changes. This can happen in the vulvar and vaginal areas as well as the urethra and bladder. The skin becomes thin and is more easily irritated or injured.

What are the signs and symptoms?

  • Problems with urination (peeing), such as:
    • Frequency (peeing often)
    • Burning
    • Urgency (needing to pee quickly)
    • Loss of urine
    • Pain
    • Urinating at night
  • Vulvar burning and/or itching
  • Bleeding or spotting
    • Come in for an evaluation if this happens often or is not normal.
  • Pain with sex
  • Vaginal dryness

How is it tested?

  1. Your health care provider will check your vulva and vaginal skin.
  2. We will look at a sample of your vaginal discharge with a microscope.
    • This will be used to decide if you have the changes normally seen with atrophic vaginitis.

What is the treatment?

It can be one of these:

Types of estrogen replacement therapy are:

Systemic estrogen

Gives estrogen to the whole body. This is normally safe, but for some women this is not a good choice. Your health care provider will let you know if this is safe for you.

If you still have a uterus and are on systemic estrogen, you will also get a hormone called progesterone.

Oral estrogen

This involves taking an estrogen pill as told by your health care provider.

Transdermal patch

  • This is a patch that is put on 1 or 2 times a week.
  • It gives the estrogen hormone through the skin.
  • It is put on the upper parts of your body.


Plant derived phytoestrogens can be found in soy milk, soy nuts, tofu, or black cohosh.

You can also get phytoestrogens as nutritional supplements called soy isoflavones.

Topical or vaginal estrogen

Gives estrogen directly into the vagina with an applicator or put directly on the vulvar skin.

Vulvar-vaginal topical cream

This is put into the vagina with a vaginal applicator or put directly to the vulvar skin.

Vaginal tablet or ring

The tablet is put in the vagina with an applicator.

You will put the ring into your vagina.

Other helpful hints

  • Use a lubricant with sex. Vegetable oil, olive oil, coconut oil are good choices.
  • Place a small amount of vegetable oil on the vaginal applicators to put it in.
  • Cooling packs, as needed.
  • Baking soda baths.
    • Soak in lukewarm (not hot) bath water with 4 to 5 tablespoons of baking soda.
    • Soak 1 to 3 times a day for 10 minutes.
Last reviewed: 
March 2020

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