Postmenopausal vaginitis

Abstract

The importance of vaginitis in postmenopausal women will increase as the US population ages. With the withdrawal of estrogen, the vaginal environment changes dramatically. Along with physical changes, an overall decrease in the normal Lactobacillus-dominant flora and Candida colonization occurs. Trichomoniasis-, vulvovaginal candidiasis, and bacterial vaginosis still occur in menopausal women but probably less commonly than in younger women. The effects of exogenous estrogen on these conditions remain unknown. Less common conditions such as desquamative inflammatory vaginitis and lichen sclerosus gain relative importance in this population.

Pathogenesis, Diagnosis and Treatment of Vaginitis and Cervicitis in Clinical Practice

“…Estrogen deficiency vaginitis is seen in postmenopausal women and in younger women who have become estrogen deficient because of disease or because of treatment with pharmaceuticals that interfere with the production of estrogen [57].This condition can also be seen during breastfeeding because of an effect of prolactin on estrogen production. [58].Without estrogen vaginal mucosa thins.…”

Clinical Spectrum of Desquamative Inflammatory Vaginitis

“…DIV has been reported to occur in women of any age [7,13], exclusively in premenopausal women [4, 14, 15•], and to occur more frequently in postmenopausal women [16]. Although some investigators note that DIV often occurs in the presence of apparently normal ovarian function [4,7,13], others report that it is more frequently diagnosed in estrogendeficient older nonmenstruating women [1,16]. DIV was identified in 8% of women presenting with chronic vulvovaginal symptoms to a vulvar specialty clinic [16].…”

“…Although some investigators note that DIV often occurs in the presence of apparently normal ovarian function [4,7,13], others report that it is more frequently diagnosed in estrogendeficient older nonmenstruating women [1,16]. DIV was identified in 8% of women presenting with chronic vulvovaginal symptoms to a vulvar specialty clinic [16]. However, the population prevalence remains unknown.…”

“…The most commonly reported symptom is the presence of an intractable, purulent vaginal discharge that has often persisted for years and is sometimes associated with vulvar soreness, burning, and dyspareunia [7,8,16]. Vulvovaginal itching may similarly be noted [8,19].…”

“…Although postmenopausal patients with DIV did not demonstrate improvement in their symptoms with local estrogen therapy alone [15•], the addition of exogenous estrogen after initial treatment with intravaginal clindamycin has been suggested in an effort to decrease the likelihood of symptom recurrence [16]. It is believed that the addition of vaginal estrogen creates an environment more favorable to the growth of lactobacilli [11].…”