What is Urogenital Atrophy?

Urogenital Atrophy is a condition which most often occurs during and after the menopause when the lack of
the female hormone oestrogen affects the vagina ,urethra & bladder trigone.
After the menopause the amount of oestrogen produced by the ovaries falls. The lack of oestrogen leads to
a thinning of the tissues around the vaginal area and a reduction in the number of the small mucus
producing glands. There is also a loss of fat around the genitals producing a different appearance than
previously. As a result the vagina can become shorted, less elastic and dryer with less lubricating mucus;
the genital skin also looks paler. These changes usually take months or years and vary between women.

How common is Urogenital Atrophy?

Vaginal dryness occurs in about 1 in 4 women leading up to the menopause, it becomes more common
after the menopause when about 1 in 2 women are affected. About 7 in 10 women in their seventies have
this problem.

What signs & symptoms can occur?

The changes described above may occur but without causing any symptoms or discomfort. However, some
of the following symptoms may occur in some women. All of the following symptoms can be caused by
other medical conditions but atrophic vaginitis is a common (and usually treatable) cause of these

  • Painful intercourse – as the vagina is smaller/shorter, drier and less likely to become lubricated
    during sex, intercourse can become painful. The skin around the vagina is more easily made sore
    and this aggravates the problem.
  • Vaginal bleeding – as the vaginal and uterine tissue is thinner and more fragile it can occasionally
    lead to spotting and bleeding. If you notice any post-menopausal vaginal bleeding you must always
    report it to your GP.
  • Vulvo-vaginal Discomfort – if the vulva or vagina becomes tender and inflamed some women can
    experience constant discomfort.
  • Infection and discharge – the vagina is less resistant to infection after the menopause and
    sometimes becomes infected. An offensive (smelly) unpleasant vaginal discharge may need
    treatment from your GP.
  • Itch – the skin around the vulva is more sensitive and more likely to itch in some women. This
    produces a tendency to scratch which then makes the skin more likely to itch. An itch/scratch cycle
    follows which can be both difficult to break and quite distressing.
  • Urinary problems ( frequency/urgency to pass urine)– these may be due to thinning and
    weakening of the tissue around the neck of the bladder or around the urethra (the opening for
    urine). A prolapse or weakening of part of the vaginal wall may also cause urinary symptoms which
    may increase with age. 

There is no evidence that topical oestrogens/hormone replacement will prevent or help urinary symptoms. Urinary symptoms that may occur include one or more of the

  • Passing water too often (frequency)
  • Not being able to hold on (urgency)
  • Pain when passing urine (dysuria)