What is vaginal dryness (atrophic vaginitis) and what causes it?

Many women notice changes in their vagina and genital area after the menopause. These changes may include dryness and discomfort during sex. There may also be bladder symptoms. These can all usually be improved with treatment. Treatment options include hormone replacement therapy (HRT), oestrogen cream, vaginal tablets and lubricating gels.Before the menopause (often called the change of life) the skin and tissues around your vagina are kept supple and moist by fluids and mucus. These are made by glands at the neck of your womb. The female hormone, oestrogen, affects these glands. Oestrogen also affects your tissues in and around your vagina, causing the lining of your vagina to be thicker and more elastic. Oestrogen also stimulates the cells that line your vagina to produce glycogen. Glycogen is a compound which encourages the presence of helpful germs (bacteria) which protect your vagina from infections.

After the menopause your ovaries make less oestrogen. The lack of oestrogen leads to thinning of the tissues around your vagina and a reduction in the number of glands that make mucus. You may also lose some fat tissue from around the genital area. This may make the area also look slightly different to how it was before the menopause.

In summary, the hormonal changes that occur during the menopause make your vagina shorter, less elastic and drier. These changes usually take months or years to develop after the menopause and vary from woman to woman. Atrophic vaginitis is the medical term for the condition when these changes produce troublesome symptoms.How common is vaginal dryness (atrophic vaginitis)?

After the menopause at least half of women have some symptoms related to vaginal dryness. You are also more likely to experience symptoms as more years pass after your menopause. It is probably even more common than that, as many women are embarrassed and feel they do not want to trouble their doctor with these symptoms.What symptoms can occur?

The changes described above can occur without causing any symptoms or discomfort. However, some of the following symptoms may develop in some women. Vaginal dryness is a common (and usually treatable) cause of the following problems. However, these problems can also be caused by other medical conditions.

•     Pain when you have sex. This may occur because your vagina is smaller, drier and less likely to become lubricated during sex compared with how it was before the menopause. Also, the skin around your vagina is more fragile and this can make the problem worse.
•     Discomfort - if your vulva or vagina is sore and red.
•     Vaginal discharge. There may be a white or yellow discharge. Sometimes this is due to an infection. Infection is more likely if the discharge is smelly and unpleasant.
•     Itch. The skin around your vagina is more sensitive and more likely to itch. This can make you prone to scratching, which then makes your skin more likely to itch, and so on. This is called an itch/scratch cycle which can become difficult to break and can be distressing.
•     Urinary problems. Vaginal dryness may contribute to various urinary problems. This is because of thinning and weakening of the tissues around the neck of your bladder, or around the opening for urine to pass (the urethra). For example, urinary symptoms that may occur include an urgency to get to the toilet and recurring urinary infections.

What are the treatments for vaginal dryness (atrophic vaginitis)?

Not all women have all of the above symptoms. Treatment usually depends on which symptoms are the most troublesome. Because the problem is mainly due to a lack of oestrogen, it can often be helped by replacing the oestrogen in your tissues.

Oestrogen creams and other topical preparations

A cream, vaginal tablet or ring containing oestrogen is often prescribed. A vaginal tablet is a very small tablet that you insert into your vagina with a small applicator. The ring is a soft, flexible ring with a centre that contains the oestrogen hormone. This ring releases a steady, low dose of oestrogen each day and it lasts for three months.

These preparations work to restore oestrogen to your vagina and surrounding tissues without giving oestrogen to the whole body. Usually the treatment is used every day for about two weeks, and then twice a week for a further three months. After this the effect of the treatment is usually assessed by your doctor. This treatment usually works well but the symptoms may recur some time after stopping the treatment. Repeated courses of treatment are often necessary or many women simply use this treatment for a much longer period of time. These preparations should not be used as additional lubrication during sex; lubricating gels should be used instead.

Note: the oestrogen creams may damage latex condoms and diaphragms; if you are using these types of contraception then it would be preferable either to use vaginal tablets or the vaginal ring.

Hormone replacement therapy (HRT)

This means taking oestrogen in the form of a tablet, gel or patches. This is often the best treatment for relieving your symptoms, especially if you are experiencing other symptoms of the menopause. There are advantages and disadvantages of using HRT. See separate leaflet called Menopause and Hormone Replacement Therapy (HRT) for more details.

Lubricating gels

If vaginal dryness is the only problem, or hormone creams are not recommended because of other medical problems, lubricating gels or moisturisers may help. There are different lubricants which can work really well to improve the dryness during sexual intercourse. These include Sylk® and Yes®. You can buy these from the pharmacy and your pharmacist should be able to advise you.

Vaginal moisturises such as Replens MD® and Hyalofemme® can work really well to improve the moisture in your vagina. These need to be used regularly.

Note: Vaseline® can break down the latex in condoms, so is not recommended for women whose partners are using condoms.

Your symptoms should improve after about three weeks of treatment. You should see your doctor if your symptoms do not improve, as sometimes these symptoms can be due to other conditions. It is also very important to see your doctor if you have any bleeding from your vagina if you are receiving hormone treatment.

Brown Vaginal Discharge

Most brown vaginal discharges are harmless or a natural process for the female body. Light brown discharges usually go away on their own within a few days. Dark drown discharges can be more serious and should be checked out.

Vaginal discharge is a normal, even healthy, occurrence. A vaginal discharge is the excess mucus and fluid that is produced by the vaginal walls and cervix. A vaginal discharge is the body's way of cleaning the vaginal area and keeps the vaginal environment healthy. The discharge removes dead skin cells and bacteria from the vaginal area. This sort of self-cleaning method is necessary for preventing infections. 

The interaction between the hormones called estrogen and progesterone is largely responsible for the female's bodily changes during the different stages of the female menstrual cycle. It is common for the color, texture, and the amount of discharge to vary, depending on the stage of the cycle. For example, during the ovulation stage you may notice an increase in the discharge. In addition, light spotting is not usually a reason for concern. If you experience other symptoms with the spotting, consult your gynecologist.

Causes of Light Brown Vaginal Discharge

There are a few reasons why a woman's vaginal discharge may be brown in color. The most common two are pregnancy and Perimenopause.

•     Pregnancy. A pinkish brown colored discharge is an early sign of pregnancy.

•     Perimenopause. Perimenopause can cause a light brown discharge, pink, or a yellow discharge. In some women, the discharge may be heavy and uncomfortable.
•     Implantation Bleeding. This is another early sign of pregnancy. The discharge can be light brown, pink or red. This type of discharge is normal and usually occurs 10 -14 days after conception. The discharge is caused by the egg implanting itself to the uterine wall. It usually appears as a single smear of discharge not a spotting or flowing type.
•     Old Endometrial Tissues. A light brown discharge is common in young girls before they start their menstrual cycle. In women, the discharge is the body's way of releasing any old endometrial tissue that was not shed during the menstrual cycle.
•     Atrophic Vaginitis. Atrophic vaginitis can cause a brown discharge, bleeding, pain or itching in the vaginal area. A woman may also experience painful intercourse, burning sensation, dryness; the discharge may be yellow in color and have a foul smell.
•     Uterine Polyps. Uterine polyps are also called endometrial polyps. The Polyps can cause a discharge as well as bleeding after intercourse, heavy menstrual bleeding, and abnormal vaginal bleeding.
•     STDs. A light brown discharge can be an early symptom of a sexually transmitted disease (STD). The most common STDs that cause a discharge include chlamydia, trichomoniasis, gonorrhea, and genital warts.

Causes of Dark Brown Vaginal Discharge

There are seven common reasons a woman may experience a dark brown vaginal discharge. Most of the reasons are not serious however; a few are so it is important to set up an appointment with your gynecologist if you have other symptoms of a serious condition or for peace of mind.

•     Pregnancy. A dark brown discharge usually is implantation bleeding. The color can range from pink, red to light or dark brown. The discharge may last as long as three to four days.
•     Ovulation. During the process of the egg being released it is not uncommon to experience a dark brown discharge or spotting. It will usually only last a few days.
•     Menopause. Many women who are close to menopause will experience a dark brown discharge in place of a normal menstrual flow.
•     Endometrial Bleeding. Endometrial bleeding occurs when some of the uterine wall was not discharged during the menstrual cycle. It may occur just after the cycle ends or just before the next cycle begins. Because the blood is old, it becomes dark brown in color.
•     Pelvic Inflammatory Disease. Pelvic Inflammatory disease is a more serious condition and requires a visit to the gynecologist. This disease happens when there is an infection in the uterus lining, fallopian tubes, ovaries, cervix and/or the vagina. It is painful and can lead to pain during intercourse, abdominal pain, and infertility if left untreated.
•     Cervical Cancer. Cervical cancer is by far the most serious disease that is associated with a dark brown discharge. Cervical cancer is spread through the HPV virus (human papilloma virus.)Other symptoms of cervical cancer can include loss of appetite, weight loss, leg pain, pelvic pain, and fatigue.

Complications of Brown Vaginal Discharge

•     Often the discharge will have a foul odor
•     Itching
•     Burning sensation
•     Pain in the vaginal area
•     Swelling in the vaginal area
•     Painful intercourse

Diagnosing the cause of light brown or dark brown vaginal discharge is as easy as visiting the gynecologist. They will be able to determine the cause based on the answers you provide to their questions, a pelvic exam, and possibly some other tests if your pelvic exam does not show a cause for the discharge.

Treatments and Preventions of Brown Vaginal Discharge

Some conditions that cause a light brown discharge such as pregnancy and implantation bleeding cannot be treated, as they are a natural process the body goes through.

If you have other symptoms or your discharge lasts longer than a few days, it is always a good idea to see your gynecologist. Treating a brown discharge depends on why you are experiencing the discharge.
Treatments for Brown Vaginal Discharge

•     STDs. Sexually transmitted diseases require antibiotics.
•     Menopause. The discharge cannot be treated it has to run its course but other related symptoms can be treated.
•     Uterine Polyps. Hormonal medications can help shrink the polyps and reduce some of the other symptoms. A procedure called curettage may be performed. This procedure will allow the doctor to scrape the polyps off of the uterus walls. The polyps will then be sent to lab for examination. Polyps are usually not cancerous. The last option is a hysterectomy, this will remove all of the polyps and again these will be sent to lab to be examined. In the event they are found to be cancerous, your doctor will discuss future treatment options with you.

•     Cervical Cancer. The treatments for cervical cancer include surgery to remove the cancer, chemo and radiation.

Preventions of Brown Vaginal Discharge

The best prevention for brown virginal discharges depends on the cause of the discharge. You cannot prevent certain discharges such as the following.

•     Pregnancy
•     Ovulation
•     Menopause
•     Endometrial bleeding

The following causes of discharges can be prevented by receiving medical attention. This may require medications or surgical intervention.

•     STDs
•     Pelvic Inflammatory Disease
•     Uterine polyps
•     Cervical cancer

In addition, to the above listed preventive measures , you can

•     Wear cotton underwear.
•     Wear lose fitting undergarments.
•     Change your tampon or sanitary napkin frequently during your menstrual cycle.
•     Avoid douching as it can increase your risk of developing an infection by throwing off your body's natural pH level