Vulvovaginal Health Management in Postmenopausal Women

Menopause brings a decline in circulating oestrogen that profoundly alters the structure and function of the vulvovaginal tissues. The epithelial thinning, reduced collagen and elastin content, diminished vascular perfusion and shifts in pH collectively give rise to vulvovaginal atrophy, characterised by dryness, burning, itching and dyspareunia. Concomitant changes in the lower urinary tract may manifest as frequency, urgency and recurrent infections. These symptoms, grouped under the umbrella of the genitourinary syndrome of menopause, exert a substantial toll on quality of life, sexual wellbeing and psychosocial health worldwide. Effective management hinges on early recognition, patient engagement and a personalised strategy. First-line measures include non-hormonal moisturisers and lubricants, supported by vaginal oestrogen preparations that restore mucosal integrity with minimal systemic absorption. Emerging selective oestrogen receptor modulators and dehydroepiandrosterone formulations offer alternative hormonal approaches for women with contraindications to conventional therapy. In parallel, energy-based devices such as fractional lasers and radiofrequency have shown promise in re-modelling collagen and enhancing vascularity, although long-term safety data remain under evaluation. A multidisciplinary framework that integrates gynaecological, urological and psychosexual expertise is pivotal to optimising outcomes and preserving urogenital health as women age.

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Vulvovaginal Health Management in Postmenopausal Women publication trend

The graph below shows the total number of articles in vulvovaginal health management in postmenopausal women across all publications each year (not limited to Nature Index journals).

Technical terms

Vulvovaginal atrophy (VVA): Thinning and inflammation of the vaginal epithelium due to oestrogen deficiency.

Genitourinary syndrome of menopause (GSM): The constellation of genital, sexual and urinary symptoms arising from hypoestrogenism in postmenopausal women.

Local oestrogen therapy: Topical administration of oestrogen (cream, tablet or ring) to restore vulvovaginal mucosal health with minimal systemic absorption.

Fractional CO2 laser therapy: A device-based approach delivering micro-ablative energy to stimulate collagen remodelling and tissue hydration in the vaginal mucosa.

Erbium-doped YAG laser (Er:YAG): A non-ablative laser modality that heats the vaginal mucosa to promote neocollagenesis and improved tissue elasticity.

Dyspareunia: Painful sexual intercourse commonly resulting from vulvovaginal tissue changes in menopause.

References

1. Minimally invasive, non-ablative Er:YAG laser treatment of stress urinary incontinence in women—a pilot study. Lasers in Medical Science (2016).
2. Long-term effect of thermoablative fractional CO2 laser treatment as a novel approach to urinary incontinence management in women with genitourinary syndrome of menopause. International Urogynecology Journal (2017).
3. Addressing Vulvovaginal Atrophy (VVA)/Genitourinary Syndrome of Menopause (GSM) for Healthy Aging in Women. Frontiers in Endocrinology (2019).
4. The Genitourinary Syndrome of Menopause: An Overview of the Recent Data. Cureus (2020).
5. Local Oestrogen for Pelvic Floor Disorders: A Systematic Review. PLOS ONE (2015).