Atrophic vaginitis: Difference between revisions
Line 2: | Line 2: | ||
*Also known as: vulvovaginal atrophy, vaginal atrophy, genitourinary syndrome of menopause, and estrogen deficient vaginitis | *Also known as: vulvovaginal atrophy, vaginal atrophy, genitourinary syndrome of menopause, and estrogen deficient vaginitis | ||
*Primarily occurs in peri or postmenopausal women | *Primarily occurs in peri or postmenopausal women | ||
* | |||
===Risk Factors=== | |||
*Conditions or medications that induce a low estrogen state: | |||
**Natural menopause | **Natural menopause | ||
**Bilateral oophorectomy | **Bilateral oophorectomy |
Revision as of 12:47, 25 November 2021
Background
- Also known as: vulvovaginal atrophy, vaginal atrophy, genitourinary syndrome of menopause, and estrogen deficient vaginitis
- Primarily occurs in peri or postmenopausal women
Risk Factors
- Conditions or medications that induce a low estrogen state:
- Natural menopause
- Bilateral oophorectomy
- Spontaneous premature ovarian failure
- Ovarian failure due to radiation or chemo
- Medications: tamoxifen, danazol, medroxyprogesterone, leuprolide, ganirelix
- Postpartum reduction in estrogen production
- Prolactin elevation
Clinical Features
Symptoms are generally progressive and gradually worsen as women progress through menopause
- Vaginal dryness
- Vaginal burning/irritation
- Decreased vaginal lubrication
- Dyspareunia
- Vulvar or vaginal bleeding
- Vaginal discharge
- Pelvic pressure
- UTI symptoms
Differential Diagnosis
- Infection (candidiasis, bacterial vaginosis, trichomoniasis, desquamative inflammatory vaginitis)
- Reaction to irritants (soaps, deodorants, lubricants, clothing)
- Vulvovaginal lichen planus
- Vulvar lichen sclerosus
- If bleeding present, malignancy should be excluded
Vulvovaginitis
- Bacterial vaginosis
- Candida vaginitis
- Trichomonas vaginalis
- Contact vulvovaginitis
- Atrophic vaginitis
- Lichen sclerosus
- Tinea cruris
- Chlamydia/Gonorrhea infection
- Vaginal foreign body
Evaluation
- History
- Menstrual and medication history to assess for causes of hypoestrogenism
- Complete ROS to rule out other causes of urogenital symptoms
- Consider symptoms that may be secondary to infection, inflammation, local irritation
- Ask about history of pelvic radiation
- Thorough sexual history
- Pelvic Exam
- External genitalia may show scarce pubic hair, diminished elasticity, introital narrowing, or fusion of labia minora
- Loss of labial fat pad
- Pale, dry epithelium that is smooth and shiny with loss of rugation
- Use caution as exam can cause pain and bleeding
- Assess for introital stenosis with gloved finger before inserting speculum
- Labs
- Not usually necessary in ED unless concern for other causes
Management
- Topical estrogen cream or tablets
- Warm patients about possible side effects of breast or perineal pain and uterine bleeding
- Estrogen should not be used if history of cancer to reproductive organs or postmenopausal bleeding
Disposition
- Refer to gynecologist