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Wulf H. Utian, MD, BCh, PhD, DSc(Med), FRCOG, FACOG, FICS

Women’s Health Consultant;
Consultant, Gynecology and Women’s Health, The Cleveland Clinic;
Chair Scientific Board, Rapid Medical Research, Inc.;
Professor Emeritus, Case Western Reserve University;
Visiting Professor, University of Cape Town, South Africa;
Honorary Founding President and Executive Director Emeritus, NAMS

Wulf H. Utian is a physician, reproductive endocrinologist, clinical researcher, and academic women's health department administrator. He is best known for first recognizing menopause as a potential health-related issue. He is the co-founder of the International Menopause Society and founder of the North American Menopause Society. Previously he has worked as a medical department Director at the Mount Sinai Medical Center, the University Hospitals of Cleveland, and academic chairman of the department of Reproductive Biology at Case Western Reserve University School of Medicine. He is currently the Arthur H. Bill Professor Emeritus of Reproductive Biology at the Case Western Reserve University School of Medicine, a consultant in women's health, and Scientific Director Emeritus of Rapid Medical Research

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Ask the Expert

Vaginal Atrophy

Can you tell me about vaginal atrophy?

Ask the Expert


Can you tell me about vaginal atrophy?


You're talking about changes that occur in the vagina as women age. These changes become more pronounced after menopause, when estrogen levels significantly drop. That's because estrogen plays an important role in this part of your body, helping maintain moistness and elasticity.

So when the estrogen dries up, so, too, can your vagina. Unlike hot flashes, however, which tend to begin before women actually reach menopause, urogenital symptoms may not begin until several years after menopause and may continue (and get worse) as you age. It's estimated that such problems affect about 20 million women in the United States, most of them over age 50. By age 75, it's estimated that two out of every three women are affected.

The loss of estrogen and its effect on the lining of the vagina can lead to itching, burning, pain and discomfort during intercourse. If the lining of the vagina becomes thin enough, it can even result in some vaginal bleeding. This thinning also makes you more susceptible to infections, which could result in a foul odor and discharge.

In addition to or instead of vaginal symptoms, you may also notice problems with bladder control and an increased incidence of incontinence, or urine leakage. Again, it's related to the loss of estrogen. This loss of estrogen may result in an atrophying, or thinning, of the lining of the urethra and other parts of the urinary tract. Thus, you may find you have to urinate more often, particularly at night, and that these urges come on more suddenly. You may also find you're experiencing more urinary tract infections.

The best treatment for vaginal symptoms is estrogen therapy. In many instances, vaginal treatment with a pill or cream inserted into the vagina, or with an estrogen ring, can provide relief. In other instances, you may require estrogen via an oral pill, patch, cream or gel. Certain lifestyle approaches may also help. For instance, the more sexually active you are, the fewer vaginal problems you're likely to have.

Estrogen therapy doesn't seem to work as well in alleviating urinary symptoms, however. Instead, talk to your health care professional about other options, including retraining the bladder and urethra muscles through various exercises, surgery and new medications designed to address incontinence.

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