Vulvovaginitis, Estrogen Deficient
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- Estrogen-deficient vulvovaginitis is a hypoestrogenic state with external genital, urologic, and sexual sequelae.
- Estrogen deficiency affects all tissues in the female body; however, the genital tissues are especially hormone responsive and are most affected.
- Decreased estrogen leads to decreased blood flow to vaginal tissues and thinning of vaginal tissues, dryness, and atrophy. Patients with estrogen-deficient vulvovaginitis may present with urinary incontinence, vaginal burning and itching, dyspareunia, increased urinary frequency, recurrent UTIs, or various other symptoms.
- This condition is also referred to as genitourinary syndrome of menopause when associated with the postmenopausal state, although this condition may occur in women of all ages.
- System(s) affected: reproductive
Predominant age: postmenopausal females. The average age of menopause in the United States is 51.3 years but ranges from 45 to 55 years old.
- Approximately 40–54% of postmenopausal women are affected.
- Approximately 15% of premenopausal women are also affected.
- This condition is likely underdiagnosed because patients may be reluctant to report symptoms because of embarrassment or the misconception that symptoms should be accepted as a natural part of aging (1).
Etiology and Pathophysiology
- Estrogen is vasoactive, increasing blood flow to target tissues, lubrication, and elasticity.
- Decreased estrogen levels in the vagina and vulva result in decreased blood flow and decreased lubrication and elasticity of vaginal and vulvar tissues as well as thinning of these tissues.
- Decreased cellular maturation results in decreased glycogen stores, which affects the normal vaginal flora and consequently the pH.
- The resulting increased pH impairs the viability of the normal flora, permitting the proliferation of fecal and other flora, resulting in UTIs and vaginal infections (1)[C].
- Estrogen deficiency is caused by the following:
- Menopause (surgical or natural)
- Premature ovarian failure (chemotherapy, radiation, autoimmune, anorexia, genetic)
- Postpartum estrogen deficiency in lactating women
- Medications that alter hormonal concentration, such as gonadotropin-releasing hormone agonists, tamoxifen, danazol, medroxyprogesterone, and aromatase inhibitors
- Elevated prolactin from hypothalamic–pituitary disorders
No known pattern
- Estrogen-deficient states, including lactation
- Alcohol abuse
- Sexual abstinence or decreased frequency of coital activity
- Lack of exercise
- Absence of vaginal childbirth
- Radiation therapy
Commonly Associated Conditions
- Urge and stress urinary incontinence
- Pelvic organ prolapse
- Frequent UTIs
- Bacterial or fungal vulvovaginitis
- Vaginal stenosis
- Loss of libido