Thinning of Vaginal Mucosal Lining and Estrogen

Atrophic vaginitis is the thinning of the vaginal mucosal lining. In a woman who has normal ovarian function, the mucosal lining of the vagina is approximately fifty cell layers thick. After the menopause, the lining begins to thin due to very low estrogen levels. Over time, the lining becomes so thin, that it may go down to one or two cell layers and as a consequence, intercourse may become very uncomfortable and possibly painful. Other issues associated with the thinning of the vaginal mucosal lining are urinary tract and vaginal infections.

The vagina is an estrogen-dependent organ. It is possible to use very small amounts of estrogen, applied locally to the vaginal mucosa, to help the tissue of the vagina get back to its normal condition. This prevents the complications of dryness, discomfort, infection and the possibility of increased risk of bladder infections.

There are specifically made estrogen creams, estrogen tablets, or estrogen rings, that when placed in the vagina in small amounts, two times per week (spaced between 3 and 4 days apart), will restore the vaginal mucosa back to normal. The Estring is a ring that is placed in the vagina and left there for three month intervals.

There is minimal to no systemic absorption of these estrogens. Hence, there is minimal to no risk. Because there is little to no absorption, there are also no systemic benefits of vaginal estrogen. So there is no protection to the bone, no relief of hot flashes, no sleep benefits or other benefits of hormone replacement. On the other hand, there should be little to no risk of embolic events such as heart attack and stroke, deep vein thrombosis, or pulmonary embolus. There should also be no increased risk of breast cancer. However, the use of vaginal estrogen in patients who do have breast cancer continues to be a controversial topic and there is no consensus of opinion as to its safety.

Estradiol absorption should be monitored to insure the safety of its use. This can be done by drawing serum Estradiol levels, measuring endometrial lining thickness by vaginal ultrasound, or by progesterone withdrawal testing. This should be done once or twice a year.

— Debra G. Kenward, MD
South Miami, FL

Information found on Minerva Medica is for consumer education use only, and not to be considered as, or a substitute for, a physician's or health care professional's treatment, diagnosis or advice.

NOTE: Minerva Medica supplies a Delivery Device with generic markings. The GM stands for gram and therefore stands for weight. Based on that, the specific gravity of the vaginal cream has an effect on the location of the dosage mark. The customer assumes responsibility for correct dispensing dosage as per their prescription from their health care provider and medical product producer.