As a woman reaches menopause, the walls of the vagina start to become thin and dry. This happens due to a sudden decrease in the levels of estrogen in the body. This dryness can lead to inflammation in the vagina, which can cause discomfort and even severe pain during sexual intercourse. This dryness and thinning of the vaginal walls is called vaginal atrophy. The resulting pain is known as dyspareunia.

1. Symptoms

Estrogen is the main female reproductive hormone and affects many aspects of a woman’s health. Vaginal atrophy, which is caused by reduced estrogen levels, can produce the following symptoms:

• Lowered libido
• Dryness in the vagina
• Severe pain during sexual intercourse (dyspareunia)
• Sensation of tightening in the vagina
• Bleeding post sexual intercourse
• Increased frequency of urination
• Increased vaginal infections

Dyspareunia is one of the main symptoms of vaginal atrophy that affects women during menopause. Dyspareunia in menopause and during the post-menopausal phase is extremely stressful for women, both physically and emotionally. It can put a strain on relationships. Many women are often reluctant to seek help for dyspareunia in menopause, as they feel embarrassed and would rather view the situation as a natural process of aging.

2. Diagnosis and treatment of vaginal atrophy and dyspareunia in menopause
Since dyspareunia is the result of vaginal atrophy, treating one is the solution for the other. Diagnosis is done with the help of a careful evaluation of symptoms, as well as urine test, pelvic examination, and vaginal acid balance test.

Treatment of vaginal atrophy mainly involves replenishing the body’s lost levels of estrogen. This can be done in many ways. The doctor can prescribe estrogen to be administered as:

• Vaginal estrogen cream
• Vaginal suppositories
• Vaginal estrogen tablet

Apart from the above medicines, the doctor may also prescribe painkillers to help ease the symptoms of dyspareunia during menopause. Some women are prescribed vaginal dilators. These dilators work to counter the effects of vaginal thinning due to menopause by stretching vaginal muscles. A doctor or a physical therapist can teach how to use the dilator effectively.

For women with severe symptoms, estrogen is administered in the form of patches or oral pills. While these are fast-acting, there are many side-effects. These side-effects include nausea, headaches, tenderness in the breasts, and digestion problems. For women who have had breast cancer, estrogen pills and patches are not at all recommended.

3. Treatment of vaginal atrophy with a history of breast cancer
For women who have had a history of breast cancer, doctors always give preference to non-hormonal treatments. These include vaginal lubricants and gels to combat discomfort due to dryness. As a second recourse, vaginal dilators can help stretch muscles in the vagina. In case none of the non-hormonal methods work, the doctor may prescribe very low levels of estrogen with careful monitoring to ensure that there is no relapse of cancer. The situation is especially delicate if the breast cancer type is sensitive to hormones.