This post was inspired by a patient reviewed at EveryWoman Health.
This lady was in her thirties and had breastfed two children in succession over the preceding 3 years and was suffering from vaginal dryness, soreness and painful sex.
She had tried various vaginal moisturisers and had been prescribed repeated courses of thrush treatment by her GP (in spite of having normal swabs) but nothing seemed to help.
After taking a thorough history and performing a genital examination to consider other important diagnoses, it was clear that the cause was lactational atrophic vaginitis….
What Is It?
Breastfeeding can cause a rise in prolactin levels, which in turn can cause a decline in oestrogen levels.
The relatively lower oestrogen levels can cause understimulation of the genitourinary system in a similar way to what can occur during the menopause and can lead to similar genitourinary symptoms such as vaginal dryness, itching, soreness, painful sex…etc
What Is It Important To Diagnose?
Many women under-report their symptoms and it is also very often misdiagnosed so a lot of women suffer in silence needlessly when the postpartum period is already a challenging time.
Lactational atrophic vaginitis is reversible and is easily treatable…
What Is The Treatment?
General vulval care is important (E.g. avoiding soap, wearing loose fitting trousers, wearing cotton underwear, using irritant-free lubricants…etc). Read more about vulval care in the article: How Can I Take Good Care Of My Vulva?
PLUS
Applying localised /vaginal oestrogen which is only needed short-term.
Note: Using regular vaginal oestrogen for 1 year is equivalent to taking just one 1mg oestrogen tablet so there is very minimal absorption into the bloodstream and should therefore not disrupt breast milk supply.
Further reading: https://gpifn.org.uk/reproductive-health/