[1] Atrophic vaginitis as well as vulvovaginal atrophy, bladder and urethral dysfunctions are a group of conditions that constitute genitourinary syndrome of menopause (GSM).

[5] Normally, estrogen helps the vagina shed old cells, which are then converted into lactic acid by good bacteria.

[15] When estrogen levels drop, this process slows down, leading to thinner vaginal tissue, less moisture, and a less acidic environment.

Those with or had a history of breast cancer may be at a higher risk of developing atrophic vaginitis due to chemotherapy and other endocrine treatments.

[16] It supports the tissues in the lower vagina and urinary tracts to keep them thick, elastic, and moist and ensuring good blood flow.

[16] Postmenopause, estrogen levels drop significantly tp 5-18 pg/mL, leading to gradual changes in the urogenital area.

[16] All tissue types such as connective, epithelial, muscular, blood vessels, and nerves are affected and become thinner and less effective, which increases risk of infections, inflammation, injuries, and sores.

Additional risk factors include smokers, those who have not given birth naturally (through the vagina), and increased prolactin levels while lactation.

The observations of the following may indicate lower estrogen levels: little pubic hair, loss of the labial fat pad, thinning and resorption of the labia minora, and the narrowing of the vaginal opening.

An internal exam will reveal the presence of low vaginal muscle tone, the lining of the vagina appears smooth, shiny, pale with loss of folds.

[28] During different life stages, such as before the first menstural cycle, during reproductive years, and after menopause, the distribution of these cell types changes.

[28] VMI is particularly useful in clinical research for evaluating the impact of hormone therapy and changes in sexual function during menopause.

[29] Recent research showed a medication called ospemifene can be an alternative oral treatment if vaginal products or hormone therapy is not suitable for patients surviving gynecological cancer.

[30] Ospemifene can increase collagen production to improve vaginal tissue, which will help reduce GSM symptoms.

[30] Topical treatment with estrogen is effective when the symptoms are severe and relieves the disruption in pH to restore the microbiome of the vagina.

[1] If a person cannot tolerate or use estrogen therapy, topical hyaluronic acid can be used as another option which has been shown to be safe and effective.

[31] Vitamin E vaginal suppositories were also found to be helpful in relieving symptoms of GSM, but further studies need to be done to evaluate how safe and effective this treatment is for this condition.

[32] Other studies have discussed using vaginal oxytocin as a treatment, but there has been no significant effect on GSM in either helping alleviate signs and symptoms or improving the condition.

The former terms do not describe the negative effects on the lower urinary tract which can be the most troubling symptoms of menopause for women.

[1][19][a] The term atrophic vaginitis does not reflect the related changes of the labia, clitoris, vestibule, urethra and bladder.

[34] In 2018, the FDA issued a warning that lasers and other high energy devices were not approved for "rejuvenating" the vagina, and it has received many reports of injuries.

[33] A 12-week randomized controlled clinical trial conducted in Ardabil, Iran, in 2018 evaluated the effectiveness of fenugreek extract on atrophic vaginitis in 60 postmenopausal women.

[38] The results indicated that while fenugreek extract showed some efficacy in treating atrophic vaginitis, it was significantly less effective that ultra-low-dose estrogen as evidenced by higher VMI scores and greater improvement in clinical signs in the control group.

[40] A 2022 systematic review evaluated randomized controlled trials to see if there were evidence to support the effectiveness of using vaginal Vitamin E and whether it helped alleviate GSM symptoms in postmenopausal individuals.

In conclusion, the review article found that vaginal vitamin E can be used to helping with GSM symptom but further studies need to be conducted to confirm its efficacy and safety.