Atrophic vaginitis - Revision history

Rossdonaldson1 at 19:56, 3 August 2022

2022-08-03T19:56:01Z

← Revisión anterior		Revisión del 19:56 3 ago 2022
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	==Background==		==Background==
			[[File:Vulva Figure 28 02 02.jpg\|thumb\|Labeled vulva, showing external and internal views.]]
	[[File:PMC3603331 ijgm-6-153f1.png\|thumb\| Influence of estrogen on the vaginal epithelium. Before menopause, high levels of estrogen stimulate maturation of the vaginal epithelium to generate a thick layer of mature superficial cells. After menopause, lack of estrogen leaves the epithelium much thinner, with very few or no superficial cells.]]		[[File:PMC3603331 ijgm-6-153f1.png\|thumb\| Influence of estrogen on the vaginal epithelium. Before menopause, high levels of estrogen stimulate maturation of the vaginal epithelium to generate a thick layer of mature superficial cells. After menopause, lack of estrogen leaves the epithelium much thinner, with very few or no superficial cells.]]
	*Also known as: vulvovaginal atrophy, vaginal atrophy, genitourinary syndrome of menopause, and estrogen deficient vaginitis		*Also known as: vulvovaginal atrophy, vaginal atrophy, genitourinary syndrome of menopause, and estrogen deficient vaginitis

Rossdonaldson1: /* Management */

2022-03-12T13:46:52Z

Management

← Revisión anterior		Revisión del 13:46 12 mar 2022
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	==Management==		==Management==
	*Topical estrogen cream or tablets		*Topical estrogen cream or tablets<ref>Winter et al, UTIs and Estrogen: the Overlooked Link https://www.acepnow.com/article/utis-and-estrogen-the-overlooked-link/</ref>
	**From ACEP Now article <ref>Winter et al, UTIs and Estrogen: the Overlooked Link https://www.acepnow.com/article/utis-and-estrogen-the-overlooked-link/</ref>~~: "If cost and insurance coverage are issues, generic~~ estradiol 10-mcg ~~inserts are typically $40/month with a cash price and GoodRx coupon. Advise one vaginal~~ insert daily ~~for two~~ weeks, then twice weekly indefinitely~~." and "may~~ take as long as ~~two to three~~ months to see maximal benefit~~" and have to be on it indefinitely.~~		**Generic estradiol 10-mcg insert vaginally daily x 2 weeks, then twice weekly indefinitely (lower cost option)
	*Warm patients about possible side effects of breast or perineal pain and uterine bleeding		**May take as long as 2-3 months to see maximal benefit
	*~~Estrogen should~~ not be used if history of cancer to reproductive organs or postmenopausal bleeding		**Warm patients about possible side effects of breast or perineal pain and uterine bleeding
			**Should not be used if history of cancer to reproductive organs or postmenopausal bleeding

	==Disposition==		==Disposition==

Hoxbox: /* Management */

2022-02-25T15:45:48Z

Management

← Revisión anterior		Revisión del 15:45 25 feb 2022
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	==Management==		==Management==
	*Topical estrogen cream or tablets		*Topical estrogen cream or tablets
			**From ACEP Now article <ref>Winter et al, UTIs and Estrogen: the Overlooked Link https://www.acepnow.com/article/utis-and-estrogen-the-overlooked-link/</ref>: "If cost and insurance coverage are issues, generic estradiol 10-mcg inserts are typically $40/month with a cash price and GoodRx coupon. Advise one vaginal insert daily for two weeks, then twice weekly indefinitely." and "may take as long as two to three months to see maximal benefit" and have to be on it indefinitely.
	*Warm patients about possible side effects of breast or perineal pain and uterine bleeding		*Warm patients about possible side effects of breast or perineal pain and uterine bleeding
	*Estrogen should not be used if history of cancer to reproductive organs or postmenopausal bleeding		*Estrogen should not be used if history of cancer to reproductive organs or postmenopausal bleeding

Hoxbox: /* Clinical Features */

2022-02-25T15:37:30Z

Clinical Features

← Revisión anterior		Revisión del 15:37 25 feb 2022
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	*[[Vaginal discharge]]		*[[Vaginal discharge]]
	*[[pelvic pain\|Pelvic pressure]]		*[[pelvic pain\|Pelvic pressure]]
	*[[UTI]] symptoms		*[[UTI]] symptoms or recurrent UTIs

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: /* Clinical Features */

2021-11-25T13:08:09Z

Clinical Features

← Revisión anterior		Revisión del 13:08 25 nov 2021
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	==Clinical Features==		==Clinical Features==
	Symptoms are generally progressive and gradually worsen as women progress through menopause		[[File:PMC4184497 sm20001-0044-f1.png\|thumb\|Atrophy of the vulva, clitoris, and vagina consistent with atrophic vaginitis. (A) Vaginal atrophy is associated with pale, dry, shiny vulvar tissue and loss of adipose tissue in the labia majora and labia minora. (B) The prepuce and clitoris are often pale and reduced in size, while examination shows that (C) the introitus may be narrowed and friable. (D) In vaginal atrophy, the vaginal walls lack rugae and may be pale and/or erythematous.]]

			''Symptoms are generally progressive and gradually worsen as women progress through menopause''
	*Vaginal dryness		*Vaginal dryness
	*Vaginal burning/irritation		*Vaginal burning/irritation

Rossdonaldson1: /* Background */

2021-11-25T12:51:28Z

Background

← Revisión anterior		Revisión del 12:51 25 nov 2021
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	==Background==		==Background==
			[[File:PMC3603331 ijgm-6-153f1.png\|thumb\| Influence of estrogen on the vaginal epithelium. Before menopause, high levels of estrogen stimulate maturation of the vaginal epithelium to generate a thick layer of mature superficial cells. After menopause, lack of estrogen leaves the epithelium much thinner, with very few or no superficial cells.]]
	*Also known as: vulvovaginal atrophy, vaginal atrophy, genitourinary syndrome of menopause, and estrogen deficient vaginitis		*Also known as: vulvovaginal atrophy, vaginal atrophy, genitourinary syndrome of menopause, and estrogen deficient vaginitis
	*Primarily occurs in peri or postmenopausal women		*Primarily occurs in peri or postmenopausal women

Rossdonaldson1: /* Background */

2021-11-25T12:47:06Z

Background

← Revisión anterior		Revisión del 12:47 25 nov 2021
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	*Also known as: vulvovaginal atrophy, vaginal atrophy, genitourinary syndrome of menopause, and estrogen deficient vaginitis		*Also known as: vulvovaginal atrophy, vaginal atrophy, genitourinary syndrome of menopause, and estrogen deficient vaginitis
	*Primarily occurs in peri or postmenopausal women		*Primarily occurs in peri or postmenopausal women
	*~~Associated with conditions~~ or medications that induce a low estrogen state ~~such as~~:
			===Risk Factors===
			*Conditions or medications that induce a low estrogen state:
	**Natural menopause		**Natural menopause
	**Bilateral oophorectomy		**Bilateral oophorectomy

Rossdonaldson1: /* Background */

2021-11-25T12:46:25Z

Background

← Revisión anterior		Revisión del 12:46 25 nov 2021
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	==Background==		==Background==
			*Also known as: vulvovaginal atrophy, vaginal atrophy, genitourinary syndrome of menopause, and estrogen deficient vaginitis
	*Primarily occurs in peri or postmenopausal women		*Primarily occurs in peri or postmenopausal women
	*Associated with conditions or medications that induce a low estrogen state such as:		*Associated with conditions or medications that induce a low estrogen state such as:

ClaireLewis at 18:16, 27 September 2019

2019-09-27T18:16:39Z

← Revisión anterior		Revisión del 18:16 27 sep 2019
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	*Decreased vaginal lubrication		*Decreased vaginal lubrication
	*Dyspareunia		*Dyspareunia
	*Vulvar or vaginal bleeding		*Vulvar or [[vaginal bleeding]]
	*Vaginal discharge		*[[Vaginal discharge]]
	*Pelvic pressure		*[[pelvic pain\|Pelvic pressure]]
	*UTI symptoms		*[[UTI]] symptoms

	==Differential Diagnosis==		==Differential Diagnosis==
	*Infection (candidiasis, bacterial vaginosis, trichomoniasis, desquamative inflammatory vaginitis)		*Infection (candidiasis, bacterial vaginosis, trichomoniasis, desquamative inflammatory vaginitis)
	*Reaction to irritants (soaps, deodorants, lubricants, clothing)		*Reaction to irritants (soaps, deodorants, lubricants, clothing)
	*Vulvovaginal lichen planus		*Vulvovaginal [[lichen planus]]
	*Vulvar [[lichen sclerosus]]		*Vulvar [[lichen sclerosus]]
	*If bleeding present, malignancy should be excluded		*If bleeding present, malignancy should be excluded

Rossdonaldson1: /* Differential Diagnosis */

2016-09-24T11:54:28Z

Differential Diagnosis

← Revisión anterior		Revisión del 11:54 24 sep 2016
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	*Reaction to irritants (soaps, deodorants, lubricants, clothing)		*Reaction to irritants (soaps, deodorants, lubricants, clothing)
	*Vulvovaginal lichen planus		*Vulvovaginal lichen planus
	*Vulvar lichen sclerosus		*Vulvar [[lichen sclerosus]]
	*If bleeding present, malignancy should be excluded		*If bleeding present, malignancy should be excluded