Especially during menopause, hormonal changes have a major impact on women’s health. A common symptom is vulvogenital or urogenital atrophy. In this case, tissue changes in the genital area leading to a variety of unpleasant symptoms. To take into account the heterogeneity of the symptoms, the term urogenital menopause syndrome has been established.

What is vaginal atrophy?

Vaginal or vulvogenital atrophy are common terms for tissue changes in the genital area that cause unpleasant symptoms. Although younger women can also be affected, these are symptoms that creep in with the onset of menopause. Due to hormonal changes, especially in post-menopause, many women are affected by symptoms such as vaginal dryness, pain during sexual intercourse, burning, itching, increased infections, and bladder and urinary tract problems. Since the topic is very shameful, women often suffer in silence. Concomitant symptoms of vagina atrophy can be treated well. Appropriate education is therefore absolutely necessary in order to bring about change here.

Hormonal upheavals – the sharp drop in estrogen – are the main reason that the genitourinary tract changes with the onset of menopause. There is reduced blood flow and tissue loss in the area of the vagina and vulva (vulvogenital atrophy), and the urogenital area can also be affected (urogenital atrophy). Hormone deficiencies and the associated changes manifest themselves very differently from person to person, with a variety of symptoms.

What is genitourinary menopause syndrome?

Symptoms of vulvogenital or urogenital atrophy are now summarized under the term genitourinary syndrome of menopause (GSM). This makes perfect sense, as the term takes into account the variety of symptoms. This is how urogenital menopause syndrome refers to all the signs and complaints of the genitourinary tract due to the drop in sex hormones during menopause.

In addition to typical symptoms in the genital tract, these are also complaints in the urinary tract, such as excessive or nocturnal urination, pain when urinating, incontinence and increased urinary tract infections. The term urogenital menopause syndrome was coined in 2014 by the North American Menopause Society.

Urogenital Menopause Syndrome: Facts and Figures

Basically, vaginal atrophy can affect women of any age. In younger years, factors such as hormonal contraceptive methods, hormonal fluctuations, metabolic diseases, endometriosis as well as chemotherapy or radiation therapy are decisive.

However, the main cause of vulvogenital or urogenital atrophy is the sharp drop in sex hormones during menopause. Symptoms of urogenital menopause syndrome occur gradually. In the first few years after the cessation of menstruation, tissue changes are still hardly noticeable, according to statistics only in about four percent of all women. However, since the decline in sex hormones progresses , about 50 percent are already affected by up to ten years after menopause. In the later years of postmenopause, it is estimated that up to 75 percent of all women suffer from vulvogenital or urogenital atrophy.

Against the background of these figures, it may be frightening that the majority of affected women take unpleasant symptoms for granted instead of seeking advice. This is a circumstance that urgently needs to be changed. After all, treatment options are not only diverse, but also crowned with success.

How does vaginal atrophy develop?

As already mentioned, hormonal changes are the main reason for atrophy in the vulvogenital or urogenital area. Above all, the lack of estrogen is striking. With the onset of menopause, the ovaries cease to function more and more, and estrogen levels drop rapidly. This not only affects blood circulation and collagen formation, but also decreases vaginal fluid. The skin loses elasticity, and becomes thinner and drier. Not only the vagina and vulva are affected, but also the urethra and bladder. Last but not least, the lack of estrogen causes a shift in the pH value of the vagina, making the vaginal mucosa more susceptible to infections.

What are the symptoms of urogenital menopause syndrome?

Atrophic processes in the vulvogenital or urogenital area result in a variety of different complaints, the severity of which can vary from woman to woman. The main symptoms are usually vaginal dryness, vaginal itching as well as burning, discharge and pain during sexual intercourse. The latter is exacerbated by the fact that low estrogen levels have a negative effect on sexual excitability. In the worst case, it can lead to injuries during penetration, and loss of libido is not uncommon.

Due to the altered pH value of the mucous membrane, bacteria have an easier time, which promotes infections. The function of the bladder and urinary tract can also be affected. This can be seen, for example, in symptoms such as bladder weakness, increased urge to urinate, pain when urinating, urinary incontinence or recurrent urinary tract infections. The psychological effects of vaginal atrophy should not be underestimated.

Vaginal Atrophy: Symptoms at a glance

• Vaginal dryness
• Decreased excitability
• Pain during sexual intercourse
• Unfavorable shift in vaginal pH
• Itching, burning and irritation in the vaginal area
• Discharge
• Increased vaginal infections
• Loss of libido
• Bladder weakness
• Pain when urinating or frequent urge to urinate
• Urinary incontinence
• Recurrent urinary tract infections
• Psychological stress

Psychological Consequences of urogenital menopause syndrome

Vulvogenital atrophy causes many physical ailments. But, we should not ignore its psychological toll. Not only are the complaints perceived as very unpleasant, but also the sex life and the female self-image suffer. It is not uncommon for a gradual loss of libido to occur and/or sexual intercourse to cease completely. Although the level of suffering is sometimes immense, few women seek medical advice or treatment. On the one hand, this is because the topic is associated with shame, on the other hand, many of those affected are wrongly convinced that this is the course of nature and therefore unchangeable.

Vaginal Atrophy: Prognosis

It is a pity that women affected by vaginal atrophy rarely seek medical advice. After all, the prognosis can be described as very good with appropriate treatment. Existing symptoms can be alleviated with different therapeutic approaches, and long-term freedom from symptoms is possible. This reduces the level of suffering and increases well-being immensely. The treatment of urogenital menopause syndrome is always individually adapted to the wishes and needs of the patient. In any case, it is worthwhile to talk to the attending physician about an existing problem.

Treatment of Genitourinary menopause syndrome

Many treatments can ease symptoms in the vulvogenital or urogenital area. Symptoms can be treated locally, and CO2 laser therapy and PRP therapy in particular are becoming important. The risk is low and the results are positive.

Vaginal Atrophy: Local Treatment Options

Local therapy for vaginal atrophy aims to reduce existing symptoms. It aims to do so until they are completely gone. For this purpose, choose hormone-free creams. They moisturize the vulvogenital area. If these are not sufficient, there is also the possibility of local bioidentical estrogen treatment. Both approaches have their merits. But, using lubricant sometimes is good. It helps to counteract dryness and pain during sex.

Doctors often choose over-the-counter humectants to treat vaginal atrophy. They are the top choice when women have only mild symptoms or do not tolerate or refuse hormonal therapy. They are applied to the outer area of the labia and the vaginal entrance. Active ingredients are usually glycerin or hyaluronic acid. The preparations ensure that water is stored in the tissue, which leads to the vagina and vulva being moisturized. It also has a positive influence on the pH value of the vagina. The great advantage of such humidifiers is that they are easy to use and free of side effects. In contrast, their effect is quite limited, which often leads to other treatment options being considered in the long term.

The main drawback of humectants and hormonal therapy is that their effect only lasts as long as the treatments are applied. If ointments, gels, or suppositories are stopped, these symptoms usually come back quickly. They include vaginal dryness, itching, and pain during sex. Local therapy for vaginal atrophy is long-term. Many women find it time-consuming and unsatisfactory. In this case, CO2 laser therapy or PRP treatments are possible alternatives.

Hormone therapy for Urogenital disorders

If moisturizing gels and ointments do not help with urogenital complaints as desired, bioidentical hormonal therapy is an option. In this case, the existing estrogen deficiency is compensated for by appropriate medication. The active ingredients are typically estradiol or estriol. They are applied locally as ointments, gels, or suppositories.

Less commonly, injections or tablets are necessary. Such hormonal therapy delays vaginal atrophy and stimulates blood circulation and lubrication. This leads to a significant improvement in existing complaints. Although you need a prescription for the hormonal preparations, they have few side effects. This is because they only have a local effect and do not influcence your overall estrogen levels. Of course, the prerequisite for use is that there is no contraindication to hormonal therapy.

CO2 Laser Therapy for Vaginal Atrophy

CO2 laser therapy (Mona Lisa Treatment) for urogenital menopause syndrome uses light energy. In contrast to (hormonal) agents, thermal effects influence the altered tissue. In the long term, this reduces tissue breakdown and pain. It can even end all symptoms.

The targeted light pulses of the laser trigger regenerative processes. Not only is the blood circulation stimulated, but there is also the formation of new collagen and mucous membranes. The urogenital connective tissue gains elasticity and also stores more fluid depots. This has a positive effect on lubrication. The vulva and vagina now have better moisture balance. So, the pH value becomes more acidic. This change kills pathogens faster.

These processes help contain classic urogenital complaints. They occur more after menopause. Patients report that vaginal dryness as well as itching and burning in the genital area are reduced. Susceptibility to vaginal infections and bladder infections also decreases. Last but not least, positive effects on the pelvic floor curb weakness and urinary incontinence.

How does CO2 Laser Therapy for vaginal atrophy work?

The laser applicator, which is used to deliver light pulses to the genital mucosa in a targeted manner, is similar to a vaginal ultrasound probe. Before starting laser therapy, a gynecological examination excludes contraindications such as infections. While patients perceive the treatment in the vagina itself only as a slight tingling sensation, the area of the vulva is more sensitive. Therefore, a numbing cream is applied. CO2 laser therapy is therefore painless.

The laser treatment is performed on an outpatient basis and takes only a few minutes. No more than half an hour is needed for the appointment. So, the session can fit into everyday life. The laser pulses’ intensity and the number of treatments depend on the urogenital symptoms. They are adjusted for each patient. On average, mild to moderate symptoms improve a lot after about two sessions. There are about six to eight weeks between the individual appointments. It makes sense to do an annual refresher. If urogenital menopause syndrome is more pronounced, further treatment appointments may be necessary.

What are the advantages of laser therapy for urogenital complaints?

Laser therapy has a big advantage over conventional approaches for urogenital complaints. It has long-lasting effects and needs little effort. Already after the first session, patients perceive significant relief. Symptoms keep improving. This is because tissue’s regenerative processes start and continue. An annual refresher is usually sufficient to maintain freedom from symptoms. In addition, the laser therapy itself is painless and side effects are hardly to be expected.

Many patients are also convinced by the fact that the treatment method can be integrated into everyday life. Not only is hardly any time required, but the aftercare after the therapy session is also limited. In principle, the usual everyday life can be resumed immediately.

Last but not least, the positive influences of such laser treatment on the psyche and well-being should be emphasized. When the symptoms improve or go away completely it causes the quality of life to increase. Women affected by vaginal atrophy feel comfortable in their bodies again, which not only increases self-confidence, but also female self-image.

Are there any side effects to be expected with CO2 laser therapy?

Treatment with the CO2 laser is not only painless, but side effects are also hardly to be expected, as the light pulses only affect the surrounding tissue. The use of the laser itself is perceived as a tingling sensation. Increased discharge, which can also be bloody, as well as a slight burning sensation are completely normal in the days following laser therapy. This is due to healing micro-injuries in the tissue. No special aftercare is needed. But, you should avoid tampons or sex, as well as baths and saunas, for a few days. This is to not to affect the healing of the mucous membrane.

PRP for Vagina and surrounding areas

The conventional Vaginal Platelet-Rich Plasma (PRP) rejuvenation procedure involves the injection of Platelet Rich Plasma into the upper vaginal wall and clitoris. This stimulates the multiplication of stem cells and promotes the growth of younger tissue. The Growth Factors released from the activated PRP aid in collagen and elastin production, leading to tissue thickening and expansion around the clitoris and vagina. This can result in easier stimulation, sexual enhancement, and improved vaginal hydration.

Vaginal PRP is an advanced sexual rejuvenation and enhancement procedure for women aimed at addressing various sexual disorders. It is a non-surgical solution supported by clinical evidence, with numerous patients worldwide reporting improved sexual benefits.

Enriched PRP (EnPRP)

To enhance the effectiveness of PRP, some clinics also use Enriched PRP (EnPRP), which involves fortifying PRP with growth factors derived from the patient’s own blood. Enriched PRP contains over 10 times higher concentration of growth factors and cytokines compared to conventional PRP alone. This technique allows for direct injection of growth factors and cytokines, resulting in a more efficient and long-lasting effect. Which promotes collagen and elastin production, leading to tissue thickening and easier stimulation, sexual enhancement, and improved vaginal hydration.

According to the Journal of Obstetrics and Gynecology (April 2011):

• 40% of women suffer from sexual arousal disorder, but only 1 in 10 consults a specialist.
• 5% of women suffer from orgasmic disorder.
• Hormonal treatments or psychotherapies are commonly recommended, overlooking the significant role of the clitoris.

Benefits of the Vaginal PRP – Enriched PRP

These include increased libido, clitoral and vaginal sensitivity, stronger and more frequent orgasms, decreased urinary incontinence, increased vaginal lubrication, reduced painful intercourse, improved vulva skin, and treatment option for Lichen Sclerosis. Additionally, there is a potential tightening effect on the vaginal opening.

What happens during the session?

The procedure involves collecting blood, processing it to obtain PRP, and reinjecting it into the treatment area, which typically takes about two hours.

Light sedation is administered to minimize discomfort during the procedure. Results are usually noticed after the first session within a few days, with full results typically achieved after two or three sessions.
The effects can last up to 14 months due to the regenerative nature of PRP. However, repeat treatments may be necessary, typically after a year, to maintain results.

PRP has cumulative effects, so booster treatments can be safely administered sooner if desired.