What is the genitourinary syndrome of menopause (vulvovaginal atrophy)?

The genitourinary syndrome of menopause, also known as vulvovaginal atrophy, is a term that describes a multi-organ, post-menopausal condition associated with a woman’s oestrogen levels.

Here, Mr Francis Gardner, renowned consultant obstetrician and gynaecologist, provides an expert into the condition, including causes, symptoms and treatment.

What is vulvovaginal atrophy?

Vulvovaginal atrophy is a condition that women commonly develop after the menopause, unfortunately, due to oestrogen deficiency. The condition is mainly associated with the thinning of the skin of the vulva and the skin of the vagina (the skin on the outside and the skin inside), where the skin becomes very fragile, leading to a lot of discomfort, soreness and dryness as a consequence of this condition.

Oestrogen levels in a woman's body are very important. Oestrogen affects many organs, including the skin, the muscles (particularly in the pelvic floor) and certain organs like the bladder, which are impacted upon oestrogen deficiency or low levels of oestrogen. Likewise, brain function is also affected by oestrogen, with women often talking about brain fog or their thought processes not being particularly clear when they have passed through the menopause.

As a result of this complete syndrome which affects multi-organs (particularly looking in relation to things like the bones), the term ‘genitourinary syndrome of menopause’ is now used to describe this condition. ‘Vulvovaginal atrophy’ has become an older term which is specific only for the skin changes in the genital area.

How common is vulvovaginal atrophy?

Nearly every woman after the menopause will experience symptoms relating to the genitourinary syndrome of menopause. It is only if women are on a specific treatment to correct this condition that they will avoid these symptoms.

Sadly, many women also feel that the genitourinary syndrome of menopause is a natural part of ageing. For example, many women think that vaginal dryness (which is common after the menopause) is the norm, but in fact there are very effective treatments available for vaginal dryness as well as information online helping women to see that vaginal dryness and the genitourinary syndrome of menopause as a whole is entirely avoidable.

What are the main symptoms?

The main symptom of the genitourinary syndrome of menopause is vaginal dryness, which has an impact on sexual function, normal activities like sports, and bladder function as well, with increased problems with urinary continence and urgency.

In addition, there are common complaints about abnormal discharge from the vagina, which again is due to an imbalance of the bacteria within the vagina as a direct consequence of the thinning of the skin of the vagina and the function of the vaginal mucosa or skin.

What causes vulvovaginal atrophy?

The cause is low levels of oestrogen.

Low levels of oestrogen in the tissues that are sensitive to the effects of oestrogen leads to the thinning of these tissues. As a result, the oestrogen stimulation that is needed for the normal growth, thickness, and health of the skin of the vagina or the mucosa of the vagina, as well as for the production of the cells that the normal bacteria in the vagina require, becomes diminished.

Oestrogen replacement, however, will normalise these changes completely. The elasticity of the vagina will increase, allowing the vagina to become much more accommodating to sexual function and eradicating problems such as bleeding (which is common with the genitourinary syndrome of menopause).

How is vulvovaginal atrophy treated?

There are simple non-hormonal treatments available in the form of vaginal moisturisers or vaginal lubricants. However, these only treat the symptoms, not the underlying problem which is the lack of oestrogen.

For most women, oestrogen replacement is perfectly safe. Oestrogen can be taken topically on the area that is affected, either by putting creams on the vulval skin of the vagina or by putting tablets in the vagina that release the hormone that is required.

For women who have other symptoms of the menopause, having systemic treatment or whole body treatment in the form of tablets or creams is another alternative. There are various combinations that can be given, depending on whether a woman has had a hysterectomy or whether she still retains her womb.

Overall, oestrogen replacement is the standard treatment for the genitourinary syndrome of menopause. Despite this, there are some women who can’t take oestrogen replacement due to having had medical conditions in the past which prevent them from taking oestrogen now.

For example, women who have breast cancer may have a cancer that is sensitive to the effects of oestrogen. Oestrogen replacement in this case can increase the risk of the cancer coming back. As a result, this group of women may be recommended either conservative treatments (with vaginal moisturisers or lubricants) or other treatment options such as the MonaLisa Touch® laser therapy, which is the only laser currently certified for the treatment of the genitourinary syndrome of menopause. This laser works non-hormonally, creating a reaction to the laser energy that mimics the effects of oestrogen treatment and restores the vagina. It has thus become the new kid on the block, so to speak, transforming the lives of women who have had conditions like breast cancer that have been very debilitating and helping to return function back to normal.

If you are living with symptoms of the genitourinary syndrome of menopause (vulvovaginal atrophy), don’t hesitate to reach out to Mr Francis Gardner for treatment and advice via his Top Doctors profile today.