Management of Atrophic Vaginitis in Postmenopausal Women with a Uterus

Initial Assessment and Non-Hormonal Options

• Atrophic vaginitis affects approximately 50% of postmenopausal women and is characterized by vaginal dryness, discomfort, pruritis, dyspareunia, urinary tract infections, and urinary urgency 2
• First-line treatment should include vaginal moisturizers for daily comfort and water-based or silicone-based lubricants for sexual activity, as recommended by the American College of Obstetricians and Gynecologists 1, 2

Hormonal Treatment Options

• If non-hormonal options are insufficient, low-dose vaginal estrogen can be considered, with the addition of progestogen to reduce the risk of endometrial cancer, as recommended by the American College of Clinical Endocrinologists 1, 3
• Low-dose vaginal estrogen formulations include vaginal tablets, vaginal rings, and other sustained-release options 2

Alternative Options

• Ospemifene, a selective estrogen receptor modulator, may be offered to postmenopausal women experiencing dyspareunia and vaginal atrophy, as recommended by the North American Menopause Society 1
• Vaginal DHEA improves sexual function and may be an option for women who prefer non-estrogen treatments, according to the International Society for the Study of Women's Sexual Health 2

Common Pitfalls to Avoid

• Not discussing the importance of regular use of vaginal moisturizers and lubricants, which can provide significant relief even before considering hormonal options, as emphasized by the American College of Obstetricians and Gynecologists 1, 2