Vaginal Atrophy: Symptoms, Causes, and Treatment Options

Vaginal atrophy (sometimes called atrophic vaginitis) is a common condition that doesn’t always get the attention it deserves, but it can really impact your comfort, sex life, and overall quality of life. Vaginal atrophy is one of the group of symptoms that falls under the classification of genitourinary syndrome of menopause (GSM). It happens when lower estrogen levels lead to thinning of the vaginal tissues, reduced elasticity, and less natural lubrication. This can result in vaginal dryness, irritation, and even discomfort during sex.

While vaginal atrophy is often experienced after menopause, it can also happen during breastfeeding, following certain medical treatments, or in younger people with low estrogen levels. Below, we’ll explain the symptoms, causes, potential complications, and the various treatment options available. Plus, we’ll shine a light on how Evvy’s vaginal microbiome testing can help identify hidden factors, like bacterial imbalances, that might be contributing to your symptoms. 

What is vaginal atrophy?

Vaginal atrophy, now more commonly seen as a part of the genitourinary syndrome of menopause, occurs due to the thinning, drying, and inflammation of vaginal tissue that happens when estrogen levels decline. Estrogen plays a crucial role in keeping the vaginal epithelium thick, elastic, and well-lubricated. When levels fall, the vaginal walls become more fragile, blood flow decreases, and natural lubrication drops significantly.

This shift doesn’t just affect comfort during sex. It also makes the vaginal environment more vulnerable to irritation and infection. Genitourinary syndrome of menopause often extends beyond the vagina, impacting the urinary tract as well, which can increase the risk of urinary tract infections (UTIs) and urinary incontinence.

Nearly 50% of postmenopausal women experience symptoms of vaginal atrophy, though many don’t seek treatment — sometimes because they’re unaware of the condition, or they assume it’s a “normal” part of aging they have to tolerate. The truth is, while vaginal atrophy is common, it is not something you have to live with untreated. Effective therapies and supportive care are available.

How does the microbiome play a role?

Estrogen doesn’t just affect the structure of vaginal tissue; it also supports the vaginal microbiome. When estrogen is normal, it encourages the growth of Lactobacilli, protective bacteria that keep the vaginal pH low and prevent overgrowth of harmful microbes.

When estrogen drops, Lactobacillus levels decline, and the vaginal pH becomes more alkaline. This shift creates an environment where inflammation and vaginal infections, like bacterial vaginosis (BV) or recurrent UTIs, become more likely. In other words, vaginal atrophy isn’t just about thinning tissues, but also about a weakened microbial defense system.

That’s where vaginal microbiome testing can help. By identifying imbalances in your microbiome, Evvy’s Vaginal Health Test gives you and your healthcare provider a clearer picture of what’s driving symptoms, so treatment can be more targeted and effective.

Vaginal atrophy symptoms

Vaginal atrophy can show up in different ways for different people. Some experience just mild dryness, while others struggle with multiple, disruptive symptoms. The most common signs include: 

• Vaginal dryness
• Burning and itching
• Pain during sex
• Vaginal bleeding after intercourse
• A noticeable decrease in lubrication. 

For some, the vaginal opening may feel tighter, and the tissue itself may appear more fragile or prone to irritation.

It’s also very common for vaginal atrophy to overlap with urinary symptoms. Many people report recurrent UTIs, frequent urination, or a constant sense of urgency. These urinary changes are part of why the term genitourinary syndrome of menopause is used, to reflect that the urinary tract is just as affected as the vaginal walls.

Another complicating factor is that symptoms of vaginal atrophy often mimic or overlap with other vaginal health concerns, such as yeast infections, BV, or general microbiome imbalance. Itching, irritation, and unusual discharge might be mistakenly attributed to infection when, in reality, they stem from low estrogen. This can lead to cycles of misdiagnosis and mistreatment, leaving the underlying issue unresolved.

What does vaginal atrophy look like?

During a pelvic exam, vaginal atrophy may be visibly different from healthy tissue. Healthy vaginal walls are usually thick, pink, elastic, and well-lubricated. In contrast, atrophic tissue tends to look thinner, paler, and shinier, with less elasticity and fewer natural folds. There’s often reduced moisture, and the tissue may tear or bleed more easily.

For the person experiencing these changes, this translates to dryness, friction during sex, and discomfort even with everyday activities like exercise. These physical changes can be alarming, but they are also a clear signal of the important role estrogen plays in keeping the vaginal environment healthy. Recognizing these shifts can help both patients and providers differentiate between vaginal atrophy and vaginal infections or other gynecological concerns.

Causes and risk factors of vaginal atrophy

The most common cause of vaginal atrophy is estrogen deficiency, which most often happens during and after menopause. As ovarian estrogen production declines, tissues in the vagina and urinary tract lose the hormone support they need to stay thick, elastic, and well-lubricated. 

However, menopause isn’t the only time vaginal atrophy occurs. It can also happen in people who are breastfeeding, since high prolactin levels temporarily suppress ovarian estrogen. Younger women may also experience atrophy due to premature ovarian insufficiency (POI), in which the ovaries stop producing hormones before 40. Surgeries that remove the ovaries or medications that block estrogen production (such as those commonly used in breast cancer treatment) can also lead to vaginal atrophy.

Lifestyle and health factors matter too. Factors, like smoking, being underweight, chronic stress, over-exercising, and eating disorders, can also lead to a condition called functional hypothalamic amenorrhea, where the brain slows down estrogen production, causing periods to stop in premenopausal women. On rare occasions, issues with the pituitary gland or damage from treatments like chemotherapy and pelvic radiation can result in estrogen deficiency, creating similar symptoms. 

Key facts about vaginal atrophy and the microbiome

• Estrogen helps the vaginal microbiome thrive, especially by supporting Lactobacillus growth.
• When estrogen falls, vaginal pH rises, making infections and inflammation more likely.
• Vaginal atrophy often goes hand-in-hand with recurrent urinary tract infections and BV.
• Around half of postmenopausal women deal with both microbiome changes and atrophic symptoms.
• Treating atrophy alone may not fully resolve symptoms if microbiome imbalance persists.
• Microbiome testing provides clarity on whether infections, imbalance, or both are contributing.

Complications of untreated vaginal atrophy

Leaving vaginal atrophy untreated can lead to more than just discomfort. Over time, the tissue changes make the vagina and urinary tract more prone to infections and injury. Many people experience recurrent UTIs, which are not only painful but can also disrupt daily life and require frequent antibiotic use. Painful sex can strain intimate relationships, while constant dryness and irritation can lower overall quality of life.

In some cases, untreated atrophy can lead to narrowing of the vaginal canal, making exams, tampon use, or penetration increasingly difficult. Because microbiome balance is often disrupted alongside these tissue changes, there is also a greater risk of recurrent BV, yeast infections, or chronic inflammation. Taken together, these complications highlight why seeking support early is so important.

Vaginal atrophy treatment & relief

The good news is that vaginal atrophy is very manageable. Depending on your medical history and comfort level, treatment may involve lifestyle changes, non-hormonal options, hormonal therapies, or a combination approach.

Lifestyle changes and home remedies

Sexual activity, whether solo or partnered, can help improve blood flow and keep tissues more flexible. Avoiding harsh soaps, douching, or scented products can reduce irritation. Stopping smoking and maintaining overall health through nutrition and exercise also supports hormonal balance and vaginal wellness.

Vaginal moisturizers and lubricants

Vaginal moisturizers used regularly can restore hydration to vaginal tissues, while lubricants make intimacy more comfortable by reducing friction. These are safe and accessible options, especially for people who can’t (or prefer not to) use hormones. Evvy’s Hyaluronic Acid Suppositories deliver long-lasting hydration directly to the vaginal tissue, and our Soothing Vulva Cream, designed to calm irritation and protect sensitive skin. Together, these products provide gentle, non-hormonal support that can make a meaningful difference in daily comfort and sexual wellness.

Vaginal estrogen therapy

Low-dose vaginal estrogen delivered by creams, tablets, or rings is one of the most effective treatments. Because the estrogen is applied directly to vaginal tissues, it improves elasticity, lubrication, and overall tissue health with minimal absorption into the rest of the body.

Hormone replacement therapy

Systemic hormone replacement therapy (HRT) can sometimes improve vaginal atrophy, but it is usually not prescribed for this condition alone. Instead, HRT is typically recommended when someone is experiencing multiple menopausal symptoms (such as hot flashes, night sweats, or mood changes) in addition to vaginal dryness or discomfort.

Other medications and therapies

For those who cannot use systemic estrogen therapy or vaginal estrogen creams, there are other options available. These include vaginal DHEA (Prasterone), which is converted locally into sex hormones, and oral ospemifene, a selective estrogen receptor modulator that mimics estrogen’s effects in vaginal tissue. Some newer, non-hormonal treatments, such as laser therapy, are also being studied, though they are not yet widely recommended.

Microbiome-focused support

Because microbiome imbalance can exacerbate symptoms and lead to recurrent infections, Evvy’s Vaginal Health Test can be a crucial complement to medical therapy. By identifying bacterial patterns that contribute to vaginal dryness, inflammation, or UTIs, microbiome care ensures treatment plans are as personalized and effective as possible.

Supporting your vaginal health with Evvy

Like many aspects of vaginal health, vaginal atrophy is complex. It’s not only about hormone levels, but also about how those changes affect your vaginal microbiome. Evvy’s Vaginal Health Test identifies whether harmful bacteria or pH shifts are contributing to vaginal dryness, inflammation, or recurrent infections.

By uncovering these hidden factors, Evvy helps you and your provider make more informed choices about treatment. Whether you’re considering hormone therapy, trying moisturizers, or looking for non-hormonal options, microbiome testing ensures your care is personalized to your body. If you’ve been struggling with symptoms of vaginal atrophy, Evvy can be a first step toward comfort and confidence. 

FAQs about vaginal atrophy

What is vaginal atrophy?

Vaginal atrophy, often known as genitourinary syndrome of menopause, refers to the thinning and drying of vaginal tissue that occurs when estrogen levels drop. Estrogen plays a key role in keeping the vaginal lining healthy, elastic, and moist. When estrogen levels decrease, the tissues can become delicate, less lubricated, and more sensitive to irritation. While this condition is most commonly seen after menopause, younger individuals may also experience it due to factors like breastfeeding, certain medical treatments, or conditions that lower estrogen levels. The good news is that you don’t have to cope with this issue. There are safe and effective treatments available that can help restore comfort and improve tissue health.

How do I tell if I have vaginal atrophy?

The symptoms of vaginal atrophy can overlap with other vaginal or urinary issues, which sometimes makes diagnosis tricky. You may notice persistent dryness, irritation, or a burning sensation. Sex may become painful, and you might experience spotting afterward. Many people also report recurrent urinary tract infections or a frequent urge to urinate. Unlike infections, these symptoms tend to last or worsen over time rather than resolving quickly. If you suspect atrophy, the best next step is to talk to your healthcare provider. They can examine the vaginal tissue, assess hormone status, and recommend tests, including microbiome analysis, to confirm the cause.

Does a woman still get wet after menopause?

After menopause, it’s common for many women to notice decreased vaginal lubrication, mainly due to lower estrogen levels. But this doesn’t mean that arousal or pleasure is off the table. There are plenty of treatments available, like vaginal estrogen, moisturizers, and lubricants, as well as some non-hormonal options that can help restore vaginal moisture and make intimacy enjoyable again. It’s also important to remember that every woman is unique; while some may continue to produce enough lubrication after menopause, others might experience a more noticeable change. The key takeaway is that reduced lubrication is a normal and manageable part of hormonal changes, and it definitely doesn’t mean a loss of femininity or sexual function.

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