## Basic introduction
- It mainly affects postmenopausal females (average age of menopause = 51.3yrs) with 20% of cases being serious enough to warrant treatment.
## Causes of estrogen deficiency:
- Surgical or natural menopause
- Drugs such as GTRH
- Premature ovarian failure that may be due to chemotherapy, irradiation and autoimmunity
- Postpartum period and lactation (due to hypoestrogenic state that is caused by the high levels of prolactin)
- The basis of pathophysiology is the general reduction of estrogen levels in the body, including vagina and vulva
- This leads to the reduced blood flow, lubrication, vaginal and vulvar fullness, and mechanical sensitivity
- There is also reduced vaginal cell maturation that leads to the thinning of vaginal mucosa and reduced glycogen stores (that affects vaginal pH and flora).