🔑 Key Learning

  • Caused by low oestrogen → thin, dry, inflamed vaginal walls → decreased lubrication and increased infection risk
  • Most common in postmenopausal women
  • 1st line: topical oestrogen therapy (cream, ring, or tablet)

🧬 Pathophysiology

  • Oestrogen deficiency leads to thinning of the vaginal epithelium
  • Reduced lubrication → increased risk of trauma, inflammation, and infection
  • Risk factors: Post-menopausal women

👀 Clinical Features

  • Vaginal dryness, itching, burning
  • Dyspareunia 
  • Postcoital spotting or bleeding
  • Urinary symptoms such as urgency, frequency, or dysuria
    • Recurrent UTIs can occur 
  • Examination findings:
    • Pale, dry, smooth vaginal mucosa
    • Ulceration may be present
    • Narrowed introitus or tenderness on exam

💊 Management

  • 1st line: Offer low-dose vaginal oestrogen 
  • Vaginal moisturisers and lubricants (e.g. Replens, YES, Sylk) can be used alone or alongside oestrogen therapy to relieve dryness and discomfort

📝 Exam Clues & Clinchers

  • Postmenopausal woman with vaginal dryness and dyspareunia
  • Pale, smooth, dry vaginal mucosa on speculum examination
  • 1st line: Offer low-dose vaginal oestrogen 

🔗 Useful Links & References