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Vaginal atrophy

Often referred to simply as vaginal dryness, around half of women experience vaginal atrophy after the menopause1-4

What is postmenopausal vaginal atrophy?

Vaginal atrophy occurs when oestrogen levels decline after the menopause, leading to:5

Loss of vaginal elasticity5

Reduced vaginal secretions5

Thinning of vagina epithelial layers5

Rise in vaginal pH5

Vaginal dryness is the most common symptom of vaginal atrophy and causes uncomfortable vaginal symptoms, including:1,5,6
  • Itching5,6
  • Burning5,6
  • Soreness5,6
  • Painful sex5,6

The impact of vaginal atrophy

Vaginal atrophy is believed to affect approximately 6 million postmenopausal women in the UK and can have a long-lasting impact on the following:3,7,8

  • Emotional distress8
  • Reduced quality of life3,8
  • Sexual problems3,8

Hear how vaginal atrophy affected Kyriacou, Sheila, Jackie and Camille

Kyriacou, Sheila, Jackie and Camille’s stories

Treatments for vaginal atrophy

Treatments for vaginal atrophy can be:9

  • Hormonal
  • Non-hormonal
  • Combination of both
Vaginal lubricants and moisturisers9

Short-term relief from symptoms but do not treat the underlying cause

Vaginal oestrogen9,10

Treats the cause of
vaginal atrophy

Systemic HRT10

Not usually recommended as a first-line treatment for vaginal atrophy

Vaginal lubricants and moisturisers9

Short-term relief from symptoms but do not treat the underlying cause

Systemic HRT10

Not usually recommended as a first-line treatment for vaginal atrophy

Vaginal oestrogen9,10

Treats the cause of
vaginal atrophy

Vaginal oestrogen

Treats the cause of vaginal atrophy

Vaginal oestrogen is recommended by NICE and the British Menopause Society
as an effective treatment for vaginal atrophy9,10

Vaginal oestrogen can be used with moisturisers or lubricants if needed9,10

Is a progestogen required?

Delivery of oestrogen direct to the vagina avoids hepatic first-pass metabolism so that lower doses than those delivered orally can be utilised to achieve a treatment response in the vagina. The oestrogen stays within the vagina and only low levels are released into the bloodstream. These levels remain within the normal postmenopausal range. Please see the SPC for further information.

The British Menopause Society advises that additional progestogen for endometrial protection is not required9

Visit the Learning Resources Page to explore training for pharmacy teams on vaginal atrophy and how to support women with Gina

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  1. Nappi RE, Palacios S, Particco M, et al. The REVIVE (Real Women’s Views of Treatment Options for Menopausal Vaginal Changes) survey in Europe: Country-specific comparisons of postmenopausal women’s perceptions, experiences and needs. Maturitas 2016;91:81–90.
  2. Kingsberg SA, Larkin L, Krychman M, Parish SJ, Bernick B, Mirkin S. WISDOM survey: attitudes and behaviors of physicians toward vulvar and vaginal atrophy (VVA) treatment in women including those with breast cancer history. Menopause 2019;26:124–131.
  3. Nappi RE, de Melo NR, Martino M, et al. Vaginal Health: Insights, Views & Attitudes (VIVA-LATAM): results from a survey in Latin America. Climacteric 2018;21(4):397-403.
  4. Palacios S, Nappi RE, Bruyniks N, et al. The European Vulvovaginal Epidemiological Survey (EVES): prevalence, symptoms and impact of vulvovaginal atrophy of menopause. Climacteric 2018;21(3):286–291.
  5. Briggs P. Consensus statement – Urogenital atrophy. Post Reproductive Health. 2022;28(1):47-50. doi:10.1177/20533691211065808
  6. Panay N, Maamari R. Treatment of postmenopausal vaginal atrophy with 10-μg estradiol vaginal tablets. Menopause Int 2012;18(1):15–19.
  7. Office for National Statistics Population Estimates for the UK, England, Wales, Scotland, and Northern Ireland: 2022. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/datasets/populationestimatesforukenglandandwalesscotlandandnorthernireland. Accessed April 2024.
  8. Simon JA, Kokot-Kierepa M, Goldstein J, Nappi RE. Vaginal health in the United States: results from the Vaginal Health: Insights, Views & Attitudes survey. Menopause 2013;20(10):1043–1048.
  9. British Menopause Society (BMS): Menopause Practice Standards 2022. Available from BMS-Menopause-Practice-Standards-DEC2022-A.pdf (thebms.org.uk). Accessed April 2024.
  10. National Institutes for Health & Care Excellence. NICE Guideline NG23 Menopause: diagnosis and management. Available at https://www.nice.org.uk/guidance/ng23 accessed April 2024