Vaginal atrophy or lichen sclerosus?

It occurred to me that LS is not to blame for everything happening with my vulva. At five years post-menopausal, I know my estradiol is very low (I had it measured). Some form of hormone therapy probably would’ve been quite restorative years ago. I’ll get into hormones in a subsequent post.

Menopause at 44 seemed harsh to me. Didn’t they say women hit their sexual prime at 42? Thanks for the generous window of pleasure. Followed by the cliff of post-menopause.

Looking back, hormone imbalance has been an issue for much of my life. This could be due to a number of reasons (we’ve still got 22 more posts to go in this series… it’s all coming).

Photo by cottonbro on

So, how do you know if it’s vaginal atrophy or lichen sclerosus?

In the previous post, Who treats lichen sclerosus?, I identified a number of specialists who are familiar with LS. Atrophy and LS have many similar symptoms (I believe they often run alongside one another). It can be tricky to get to the root of it.

A doctor well-versed in LS should be able to give you a clear idea of what you are dealing with. A biopsy can be done to diagnose LS. Often a visual exam is enough.

Many women believe all of their symptoms are from LS. My thought is this: if LS tends to exist in a low estrogen environment, there are most likely other issues of low estrogen (thinning skin, dryness, shortened vaginal canal and lowered libido) happening at the same time.

According to the Mayo Clinic:

Vaginal atrophy (atrophic vaginitis) is thinning, drying and inflammation of the vaginal walls that may occur when your body has less estrogen. Vaginal atrophy occurs most often after menopause. For many women, vaginal atrophy not only makes intercourse painful but also leads to distressing urinary symptoms.1

Burning, dryness, itching, UTIs, shortening and tightening of the vaginal canal, and painful intercourse are all cited as symptoms of menopause. What I haven’t come across in the literature on menopause are the white patches, thickened skin, scarring, ulcers and sores on the vulva that many with LS experience. These seem to be more LS-related than menopause-related. 

If you’re not sure whether you’re experiencing LS or vaginal atrophy, talk to your doctor. Either way, a good pelvic floor therapist can help. My post, Lichen sclerosus and pelvic floor therapy, explains why this is a great addition to your menopause care team. A good PF therapist will help you treat vaginal atrophy (with or without the presence of LS).

Personally, using nourishing emollients on my vulva was one of the best things I did for my menopause health. It improved the elasticity of the skin. Topical estriol cream helped to restore the plumpness. I wish I’d known about these sooner. I talk about emollients, barrier creams and topical estrogen in Lichen Sclerosus: Body, Mind & Spirit Practices to Heal the Stress of LS.

There’s no need to suffer through mid-life. We have myriad options available to help us off the menopause cliff and back through that window of pleasure!

Much love,


Read the next post in the series: Lichen sclerosus and gluten-free

Start your healing journey today! Find out more about vulvovaginal care, managing lichen sclerosus, and menopause. Order my newest award-winning book Lichen Scerosus: Body, Mind & Spirit Practices to Heal the Stress of LS. Available worldwide in paperback and ebook from your favourite online bookseller.

Lichen Sclerosus: Body, Mind & Spirit Practices to Heal the Stress of LS

Pick up your copy of the most recently published book on LS. Everything covered in this blog series and more! 

**This blog is meant to inform, not diagnose or treat specific health conditions. It is not a substitute for professional medical advice, diagnosis and treatment. Always consult your doctor or health care practitioner.


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