May 16, 2016

VVA: What Is It, And What Does It Mean For Post-Menopausal Women?

It’s no secret that with menopause comes a variety of hormonal changes – all of which affect the body in different ways. You’ve probably heard about the hot flashes and mood swings associated with this changing time, but what about the other side effects of menopause? For SWHR’s latest installment in the Hormones Across The Lifespan series, join us as we delve into the subject!

For post-menopausal women (meaning, women who have gone more than one year since their last period and therefore have completed menopause), vaginal health issues are a prevalent concern [1]. Among these is vulvovaginal atrophy (VVA), a condition caused by lowered levels of estrogen and a decreased blood supply to the vagina [4] that impacts 20 to 45 percent of women over the age of 40 [5]. VVA affects the vagina by impacting its ability to secrete lubricant, expand and contract, and grow new cells. Over time, blood flow diminishes, and the vagina and vulva shrink as cells die off and are not replaced, resulting in thinning, drying, and inflammation of the vaginal walls [4].

The initial symptom of VVA is often lack of vaginal lubrication, eventually leading to persistent vaginal dryness and/or dyspareunia (pain with sexual contact). Thinning of the vaginal walls may also cause severe itching, soreness, and a stinging pain in the vaginal and vulvar area. Vaginal spotting, due to small tears in the vaginal epithelium, may also occur. Women with VVA may report a thin yellow or grey watery discharge secondary to the rise in pH that accompanies the condition [6].

Women with VVA often report symptoms such as urinary urgency and frequency, pain while urinating, nocturia (waking in the night due to the urge to urinate), and incontinence. Recurrent urinary tract infections can also result from VVA [6].

Unfortunately, many women do not always report their VVA symptoms to their healthcare providers, causing them to go untreated. Women are more likely to report vaginal discharge and urinary urgency but are less likely to report vaginal itching, soreness, or pain [6]. Often, women don’t report their symptoms to their healthcare providers because they feel the symptoms are not important enough, or are embarrassed about what they’re experiencing [6].

However, some women do use lubricants for relief, yet “self-treating” may not be the most effective treatment for VVA. If symptomatic vaginal atrophy doesn’t respond to self-care measures, hormone therapy is the standard of care, typically with vaginally administered local estrogens [5].

Non-hormonal treatments are also available, including over-the-counter vaginal moisturizers and lubricants. Vaginal moisturizers can be safely used long-term and should be used regularly for optimal effect [5]. Vaginal lubricants can make sex more enjoyable and easier to tolerate with or without the use of hormonal treatments.

Hormone therapy has been used for more than half a century for the management of menopausal symptoms, such as vasomotor symptoms (hot flashes, night sweats) and postmenopausal symptoms associated with VVA [7]. The North American Menopause Society notes that prescription estrogen therapy can manage many of these symptoms, including restoring vaginal blood flow, improving the thickness and elasticity of vaginal tissue, restoring a healthy vaginal environment, and relieving vaginal dryness [7].

The choice of therapy, whether hormonal or otherwise, should ultimately be guided by clinical experience and patient preference. SWHR believes that women should feel empowered to ask questions and educate themselves on changes to their health and bodies across their lifespan, including their hormonal health. To learn more about hormonal health across the lifespan, visit our website. Look for more information about hormones across the lifespan as we continue this four-part series, including a piece on questions to ask your healthcare provider to determine whether or not hormone therapy is right for you.


4. North American Menopause Society. Menopause and Aging. In: Menopause Practice: A Clinician’s Guide. 3rd edition. 2007.