Atrophic Vaginitis
From Anvita Health Wiki
Contents |
Etiology
Epidemiology
- most common cause of vaginal discharge & vaginal bleeding in post- menopausal women
Pathology
- atrophy, thinning of the vaginal epithelium
- shift in cell structure to parabasal cells
- high nuclear to cytoplasmic ratio 'blue blobs"
- cells do not produce much glycogen on which Lactobacillus depend
- vaginal pH increases to > 4.5 because of decreased lactate production
- fissures may form
- decreased height of rugae
- decreased vaginal secretions
- shift in vaginal flora from Lactobacillus to predominantly bowel-related bacteria
Clinical-manifestations
- vaginal irritation & dryness
- dyspareunia
- watery, yellow (serosanginous) discharge
- vaginal wall generally appears thin & pale, but may be erythematous
- vaginal bleeding may occur easily
- urinary urgency
- urinary frequency
- dysuria
Laboratory
-
- numerous leukocytes & basal epithelial cells
Management
-
-
- 2-4 g/day for 2 weeks
- reduce to 1-2 g for 2 weeks
- maintenance 1 g 3x/week
- patient seem to prefer tablets or the vaginal ring over cream [2]
- oral estrogens equally effective
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More General Terms
Additional Terms
- 17-beta estradiol (E2, Estrace, Estinyl, Delestrogen, Elestrin, Evamist)
- conjugated estrogens (Premarin, Enjuvia, Cenestin)
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004; 7th edition 2010
- National Guideline Clearinghouse The role of local vaginal estrogen for treatment of vaginal atrophy: 2007 position statement of The North American Menopause Society. (The North American Menopause Society) ngc-guideline: [1]
