Vaginal atrophy across the menopausal age: results from the ANGEL study

Abstract

Objectives: This study aimed to investigate the prevalence of vaginal atrophy (VA) in women across the menopausal age.

Methods: A multicenter cross-sectional investigation was performed on 747 females, 40–55 years of age, in 30 outpatient public services across the nation. The VA diagnosis was based on the combination of patient sensation of vaginal dryness, an objective sign of VA, and pH >5.

Results: VA was diagnosed in 36.8% of women. Prevalence ranged from 19.2% (40–45 year olds) to 53.8% (52–55 year olds). pH >5 (37.5%) was less prevalent than isolated VA symptoms or signs. Vaginal dryness (64.0%) was the most prevalent symptom followed by dyspareunia (54.5%), itching (38.5%) burning (38.3%), and dysuria (28.9%). Prevalence of vaginal signs declined from vaginal dryness (60.3%) to vaginal thinning (54.5%), vaginal pallor (47.4%), presence of petecchiae (15.7%), and mucosa fragility (15.1%). Most signs and symptoms showed an age-related increase in frequency and intensity. VA was independently associated (R² = 0.139; p < 0.0001) with age (odds ratio [OR] 1.08; 95% confidence interval [CI] 1.03–1.13), being in postmenopause (OR 3.45; 95% CI 2.29–5.19), and presence of vasomotor symptoms (OR 3.10; 95% CI 2.09–4.60).

Conclusion: VA and its symptoms are common in women across the menopausal age. VA identification may favor early management and treatment.

Chinese abstract

本研究旨在调查绝经女性阴道萎缩（VA）的患病率。方法：对来自全国30个门诊服务中心的747名年龄介于40-55岁的女性进行多中心横断面调查。 VA的诊断是基于患者存在阴道干燥感及阴道的客观改变, 并且pH> 5。 结果：36.8％的女性被诊断为VA。患病率从19.2％（40-45岁）到53.8％（52-55岁）不等。 pH > 5（37.5％）的女性比仅存在VA症状的女性少。阴道干燥（64.0％）是最常见的症状, 其次是性交困难（54.5％）, 瘙痒（38.5％）, 烧灼感（38.3％）和排尿困难（28.9％）。不同症状的患病率由高到低为：阴道干燥（60.3％）阴道变薄（54.5％）, 阴道苍白（47.4％）, 存在出血点（15.7％）和粘膜溃疡（15.1％）。大多数症状和体征表现出与年龄相关的频率和强度增加。 VA与年龄（比值比[OR] 1.08; 95％置信区间[CI] 1.03-1.13）, 处于绝经后期（OR 3.45; 95％CI 2.29-5.19）和存在血管舒缩症状（OR 3.10; 95％CI 2.09-4.60）独立相关（R² = 0.139; p <0.0001）。结论：VA及其症状在绝经年龄的女性中很常见。 VA诊断可能有利于早期管理和治疗。

Keywords:

• Genitourinary syndrome of menopause
• vaginal atrophy
• perimenopause
• vasomotor symptoms
• dyspareunia

Acknowledgement

The authors thank Dr A. Pecoroni for the valuable clinical advice.

Conflict of interest

No potential conflict of interest was reported by the authors.

Source of funding

The study was partially supported by an unrestricted grant from the Italian Society for the Menopause (SIM).