• Menopause
• Women's Health

What to Know About Postmenopausal Atrophic Vaginitis

Published: September 17, 2025
Updated: September 17, 2025
4 mins

As women get older, it's natural for their hormones to shift. Atrophic vaginitis, also known as vaginal atrophy, occurs when there is a significant decline in estrogen levels. Low estrogen levels during menopause can lead to vaginal discomfort from an increase in dryness and inflammation.

Atrophic vaginitis happens gradually, so you may not notice any symptoms right away. Some women may experience it for other reasons outside of menopause. Still, you can start menopausal treatment early to reduce the chances of developing severe symptoms. Hormone replacement therapy, OTC medications, and more can help you continue to feel like yourself as your body experiences changes and hormones fluctuate.

What are the Symptoms of Postmenopausal Atrophic Vaginitis?

Women who experience atrophic vaginitis may experience the following symptoms:

• Pain during sexual intercourse

• Burning

• Light bleeding while having sex

• Vaginal itching

• Thick vaginal discharge

• Urinating frequently

The duration of symptoms may vary for every woman. Nevertheless, don’t hesitate to reach out to a healthcare provider as soon as you notice symptoms. Some atrophic vaginitis symptoms resemble other sexual health concerns. Incorrectly treating atrophic vaginitis or other similar symptoms may cause symptoms to linger for longer or worsen.

What Causes Postmenopausal Atrophic Vaginitis?

As women get older and approach menopause, the body is no longer prepping the ovaries to produce eggs. Lower levels of progesterone and estrogen can contribute to atrophic vaginitis, as the body becomes less able to fight inflammation.

Breastfeeding, certain oral contraceptives, surgery, and some medications can contribute to atrophic vaginitis as well.

How is Atrophic Vaginitis Diagnosed?

A healthcare provider specializing in women’s health (gynecologist) can perform a physical exam to determine if you have atrophic vaginitis. If you have vaginal discharge as a result of atrophic vaginitis, a healthcare provider may also swab the inside of the vaginal wall to analyze the sample.

Who is at Risk for Postmenopausal Atrophic Vaginitis?

Atrophic vaginitis can affect postmenopausal women and those who go through menopause early. Early menopause is considered any period well before the age of 45 to 55. The risk of atrophic vaginitis is higher for women who have a history of surgery related to the ovaries, amenorrhea, or breastfeeding. Even if surgery doesn’t involve the removal of the ovaries, some women may still experience a decline in estrogen levels.

Treatments Options for Atrophic Vaginitis

Many women may not initially seek treatment for atrophic vaginitis because of how normalized it is to be uncomfortable during menopause. However, it’s still important for your mental and physical health to feel comfortable even when you’re going through menopause.

For mild cases of atrophic vaginitis, over-the-counter (OTC) vaginal lubricants and moisturizers may help with short-term relief. For some women, engaging in sexual activity may help to improve symptoms from natural lubrication of the vaginal walls. If symptoms persist or worsen, meet with a healthcare provider to discuss options for prescription medications.

• OTC moisturizers: If dryness or irritation only happens when you’re engaging in sexual intercourse, applying water-based lubricant to the surface of the vagina may relieve discomfort. Some water-based lubricants, like Replens, can last for three days.

• Vaginal lubricants: Along with a moisturizer, you can use a water-based vaginal lubricant during intercourse to reduce dryness. Be careful when using lubricants with different scents. Lubricants with fragrances may increase irritation.

• Hormone replacement therapy: Low-dose oral, transdermal, or vaginal estrogen can help balance vaginal pH levels and protect vaginal walls from dryness. Estrogen can help thicken vaginal walls and increase beneficial bacteria. While any form of HRT can help, low-dose vaginal estrogen is a more direct treatment.

• Prescription medications: Non-hormonal oral medications can help reduce vaginal dryness and irritation. A healthcare provider may prescribe ospemifene to treat vaginal dryness. However, this medication may not be safe for those with a history of breast cancer.

Tips for Preventing Atrophic Vaginitis

Generally, there’s no definite way to prevent vaginal atrophy. However, there are steps you can take to help prevent vaginal dryness.

Consider the following tips for managing vaginal dryness:

• Eat more foods with soy in them

• Consume vitamin D-rich foods or supplements

• Apply natural oils to the outside of the vagina

• Drink an adequate amount of water daily

• Taking probiotics may help balance healthy bacteria

While these tips may help, it’s best to get treatment from a licensed healthcare provider. The source of the vaginal dryness can change what works best for you.

How to Talk to a Healthcare Provider About Atrophic Vaginitis

It can be difficult to talk to a healthcare provider about health issues affecting your sexual health. However, the sooner you have the conversation, the quicker you can find relief. Make sure to emphasize how the symptoms are affecting you in your daily life.

If you’re uncomfortable starting the conversation, consider giving your healthcare provider a written list of the symptoms you have been experiencing at the beginning of your appointment. Telehealth platforms like LifeMD also give you the opportunity to speak with healthcare providers from the comfort of your home or through messaging. 

Where Can I Learn More About Atrophic Vaginitis?

Atrophic vaginitis is one of many common menopausal symptoms. At LifeMD, a licensed healthcare provider can help you navigate menopause and prescribe treatment for those who qualify.

For women approaching or experiencing menopause, the LifeMD Women’s Health Program offers treatment for menopause and other common women’s health concerns. With LifeMD, you can receive medical guidance from licensed healthcare professionals and access quality thyroid treatment like levothyroxine, if you qualify.  Join the waitlist today to get closer to better health.