What Are the Risk Factors for Vaginal Atrophy?

by Sheila M. Eldred Health Writer

The main cause of vaginal atrophy (VA), or genitourinary syndrome of menopause (GSM), is simple: lack of estrogen. Most often, menopause is the clear culprit of plummeting estrogen. But there are a few other risk factors that can cause estrogen to decrease and the condition to develop. We went to the experts to learn more about the risk factors for VA. Here they are.

mature woman pensive

Natural Menopause

By far, menopause—which typically happens at age 51 in the U.S.—is the biggest risk factor for VA. “It’s the loss of ovarian hormones at menopause that has a cascading effect that creates this problem,” explains Sheryl Kingsberg, Ph.D., chief of the division of behavioral medicine in the department of OB/GYN at MacDonald Women’s Hospital in Cleveland, and past president of the North American Menopause Society. The problem she’s referring to? Thinner, drier, and generally more fragile vaginal tissue that can lead to pain during sex, vaginal burning, and other issues.

middle-aged woman coffee

Premature Menopause

“It’s not just about being 51,” Kingsberg says. Many women go through menopause early, between ages 40 and 45, and others go through premature menopause before age 40. No matter when it happens, menopause means less estrogen, which is a risk factor for VA.



Yes, here’s yet another health reason not to light up: The cigarette habit may hasten menopause and be a risk factor for developing VA, says Sherry Ross, M.D., an obstetrician-gynecologist and women’s health expert in Santa Monica, CA. Smoking not only dampens the benefits of estrogen, it can also decrease the blood and oxygen flow to the vagina, according to the Mayo Clinic.

woman resting on grass

No Vaginal Births

Although it’s not clear why, it turns out that women who never gave birth vaginally seem more at risk to experience VA. And both smoking and lack of a vaginal birth are linked to an increase in severity of symptoms of VA, researchers report in an article in the journal American Family Physician.


Lack of Sexual Activity

Not having sex can be a factor that increases your risk of VA, according to the American Family Physician. Sexual activity keeps blood flowing and helps the vaginal tissues stay elastic. And you don’t even need a partner: The positive effects of sexual stimulation can be accomplished on your own, with a vibrator or a dilator, as well.



Estrogen can also plummet after giving birth, and it can stay low if you breastfeed, Dr. Ross says. Since these women are younger than the typical menopausal patient, OB-GYNs are even less likely to recognize or ask about VA, one study noted. Many of these cases are missed, the researchers conclude, making it important to educate yourself about what might be happening, as well as share info with others. “It’s a topic we really need to make less shameful and embarrassing, because a third of women have problems related to vulva/vaginal atrophy,” Dr. Ross says. “You’re in good company.”


Some Cancer Treatments

Unfortunately, many treatments that help cancer patients can have negative effects on estrogen levels, yet another risk factor for VA. That includes chemotherapy, radiation treatment to the pelvis, and endocrine therapies. The good news? Researchers are exploring new treatments that may help alleviate VA for cancer patients.

dry eyes

Immune Disorders

Even if you haven’t gone through menopause yet, some immunologic disorders can hamper production of estrogen. Women with Sjögren’s syndrome, for example, report VA two to three times more often than women who don’t have an immune disorder, according to Johns Hopkins Medicine. The autoimmune disease, which causes symptoms like dry eye and dry mouth, may also aggravate VA symptoms.

surgical equipment


When one or both of your ovaries is removed surgically, you’ll obviously have less estrogen since it’s your ovaries that produce it. While an oophorectomy can be a risk-reducing surgery for women who may be at higher risk of certain cancers, it’s important to be aware that it’s a risk factor for developing VA.

Sheila M. Eldred
Meet Our Writer
Sheila M. Eldred

Sheila Mulrooney Eldred is a graduate of Columbia’s School of Journalism and a former newspaper reporter. As a freelance health journalist, she writes about everything from life-threatening diseases to elite athletes. Her stories have appeared in The New York Times, Nature, FiveThirtyEight, Pacific Standard, STAT News, and other publications. In her spare time, she and her family love running, cross-country skiing, and mountain biking in Minneapolis.