Makindo Medical Notes

Atrophic vaginitis (also known as Genitourinary Syndrome of Menopause) is diagnosed based on the patient's clinical presentation, which includes vulvovaginal discomfort due to the thinning and inflammation of the vaginal epithelium associated with decreased oestrogen levels, typically post-menopause.

Clinical Findings

• Vaginal Symptoms: Dryness, itching, irritation, dyspareunia (pain during intercourse), and vaginal discharge.
• Urinary Symptoms: Dysuria (painful urination), frequency, and urgency. Often similar to those of urinary tract infections.
• Examination: Thin, pale vaginal epithelium, loss of vaginal rugae, and narrowing of the vaginal canal. Vaginal pH may be elevated (typically above 5).
• Additional Findings: Recurrent urinary tract infections (UTIs), urinary incontinence, or bleeding from fragile vaginal tissues may be present.

Investigations

• Typically, atrophic vaginitis is diagnosed based on clinical history and examination.
• If urinary symptoms predominate, urinalysis and urine culture may be done to rule out infection.
• In some cases, a vaginal pH test may be used (pH > 5 is indicative of atrophic vaginitis).

Management Plan: focuses on the relief of symptoms and restoring vaginal health

1. First-line Treatment:
   • Vaginal moisturisers and lubricants for symptomatic relief of dryness and discomfort.
   • Emphasize the importance of regular use rather than just prior to intercourse.
2. Hormonal Therapy:
   • Topical oestrogen therapy (e.g., estriol cream or vaginal oestrogen tablets) to restore the vaginal epithelium.
   • Vaginal oestrogen is preferred over systemic HRT in women who are not candidates for systemic oestrogen therapy (e.g., in patients with a history of breast cancer or thromboembolism).
   • Review in 3-6 months to assess symptom improvement and any side effects.
3. Systemic Hormone Replacement Therapy (HRT):
   • Considered if the patient has other menopausal symptoms (e.g., hot flashes, night sweats), alongside vaginal symptoms.
4. Patient Education:
   • Advise on lifestyle changes such as avoiding irritants (e.g., perfumed soaps), maintaining sexual activity, and encouraging pelvic floor exercises.
   • Encourage the use of non-hormonal lubricants during sexual intercourse to reduce discomfort.
5. Referral:
   • Referral to a gynaecologist if symptoms are unresponsive to topical treatment or for specialised care (e.g., if vaginal bleeding is persistent or if there is uncertainty about the diagnosis).
6. Follow-Up:
   • Plan to follow up with the patient in 3-6 months to reassess symptoms and adjust treatment as needed. Encourage patients to report any new symptoms, particularly vaginal bleeding or signs of infection.