Can Vaginal Atrophy Be Reversed?
If you’ve been diagnosed with vaginal atrophy (VA), also known as genitourinary syndrome of menopause (GMS), it’s normal to wonder whether this condition can be completely cured. After all, no one wants to deal with burning, stinging, dryness, and painful sex—and you shouldn’t have to, either. Keep reading to learn more about whether this condition can be reversed, and get the latest on treatment innovations currently under study.
What Is Vaginal Atrophy?
Before we dive into whether (and how) this condition can be reversed, it’s important to understand what VA is, and how it happens. Essentially, vaginal atrophy occurs when estrogen in the body decreases—typically around menopause—and results in physical changes, says Susan D. Reed, M.D., an obstetrician and gynecologist (OB-GYN) and program director of the Women’s Reproductive Research Program at University of Washington Medicine in Seattle. “The vaginal opening narrows, and the vaginal tissue pliability and flexibility is diminished,” she explains. These changes can result in vaginal dryness, burning, itching, pain with sex, bladder problems, and more, she says.
Can You Reverse Symptoms?
Let’s get to the big question: Can you reverse vaginal atrophy? Well, that depends on what you mean by “reverse.” The short answer is—kind of. With treatment, you can see real changes—but it might not be the 100% reversal you’re looking for. “With local estrogen products, we do see a change in the skin, and we see improvement with physical therapy and dilators—so we do see reversal of the physical changes with treatment,” explains Dr. Reed. “But do we see reversal of all the symptoms? That is the more challenging question—and the answer is not always.”
Hormonal Changes Are a Natural Part of Aging
Here’s the thing—not all women experience VA, but more than half of menopausal women do, according to the Cleveland Clinic, making it an incredibly common part of aging. “Unfortunately, after menopause, our ovaries will never begin to produce estrogen again,” explains Evelyn Mitchell, M.D., OB-GYN with Keck Medicine of the University of Southern California in Los Angeles. “So treatments are a way to manage it.” While you can’t undo the aging process, you may be able to find major relief for VA with treatment, and start feeling more like your old self.
How Estrogen Therapies Can Help—And Their Limitations
Estrogen therapies are one common treatment for VA, says Dr. Reed: “With these, we see an improvement in skin thickness, the vaginal pH, and in physical exam findings, but we don’t always see an impressive improvement in symptoms.” This has proven to be a bit of a researcher’s conundrum, she says. “While studies have shown we do see benefit with estrogen, as a clinician, it’s not as great a benefit as I would like to see for my patients.” So while estrogen may help some of your symptoms—in some cases, majorly—it’s unlikely to be a 100% VA reversal.
Research Confirms That Improved Treatments for VA Are Necessary
In a 2018 study published in JAMA Internal Medicine, for which Dr. Reed was one of the principal investigators, researchers looked at more than 300 women with vaginal symptoms. Some were treated with estrogen in tablet form, some with a vaginal moisturizer, and the rest with placebo. “The bottom line was the women in the placebo group had pretty similar benefit to the estrogen group,” says Dr. Reed. Similarly, the vaginal moisturizer didn’t appear more effective than placebo either. The study concluded that more research is needed to increase women’s satisfaction with treatment for VA.
A Newer Option in Pill Form
In terms of other treatment options for VA, estrogen therapies and moisturizers are the big players—but there’s a newer kid on the block, too. “Osphena is one of the newest developments,” Dr. Mitchell tells us. Ospemifene (Osphena) was first approved in 2013 for the treatment of VA due to menopause, specifically for severe painful sex and moderate to severe vaginal dryness, per the U.S. Food and Drug Administration. This oral pill is an estrogen agonist/antagonist, which means it works like an estrogen in the body, and research—such as a 2019 study in Menopause—has demonstrated its effectiveness.
Could Laser Therapy Help?
Laser therapy is another newer treatment option currently under study for VA. “We use laser therapy for aging skin of the face with remarkable effects, so the idea of using it in the vaginal area is the same process—you get removal of old skin and collagen so fresh skin [can grow],” Dr. Reed explains. Existing research on women who have had vaginal laser therapy is promising, but larger and stronger clinical studies are needed before this treatment can be widely recommended, she explains. “These treatments have been marketed, but data to show the amount of true benefit is still forthcoming.”
Is There Truth to ‘Use It or Lose It?’
You might’ve heard that you can treat vaginal atrophy by exercising your vaginal muscles via sex—and this might be legit. “We know that if women use dilators, they will improve the pliability of the vaginal opening, so sexual activity [may be similar], but it has never been studied,” Dr. Reed says. “There is something to keeping parts of your body active.” So again, while you may not be able to fully reverse VA this way, it may help. Open communication with your partner—or working with a sex therapist—can also help you navigate your way back to intimacy with VA.
What Does the Future Hold?
So while we can’t necessarily reverse the entire aging and physical process that leads to VA with the currently availably treatment options, there certainly are ways to manage your symptoms. “We need to do better for our patients,” Dr. Reed says. “These things do work—but how well do they work?” Thankfully, researchers are actively working to improve treatments as we speak. “[VA] is actually very simple—there’s low estrogen, so you need to replace it,” says Dr. Mitchell. “Future research will go into different ways women can get estrogen more easily. We’re looking for a longer-term solution.”
Vaginal Atrophy Information: The Cleveland Clinic. (2020.) “Vaginal Atrophy.” my.clevelandclinic.org/health/diseases/15500-vaginal-atrophy
Treatment of Vaginal Symptoms Study: JAMA Internal Medicine. (2018.) “Efficacy of Vaginal Estradiol or Vaginal Moisturizer vs Placebo for Treating Postmenopausal Vulvovaginal Symptoms.” jamanetwork.com/journals/jamainternalmedicine/fullarticle/2674257
Ospemifene Information: U.S. Food and Drug Administration. (2019.) “Highlights of Prescribing Information.” accessdata.fda.gov/drugsatfda_docs/label/2019/203505s015lbl.pdf
Ospemifene 2019 Study: Menopause. (2019.) “Efficacy and safety of ospemifene in postmenopausal women with moderate-to-severe vaginal dryness: a phase 3, randomized, double-blind, placebo-controlled, multicenter trial.” ncbi.nlm.nih.gov/pmc/articles/PMC6553508/