Signs and symptoms of vulvovaginal atrophy (VVA) in clinical practice–the possible involvement of thyroid autoimmunity in genitourinary syndrome of menopause (GSM)

Background: Thyroid autoimmune disorders (ADs) are common in midlife women and can impact various aspects of health, including sexual function. The effect of thyroid autoimmunity on the clinical manifestations of vulvovaginal atrophy (VVA) remains unclear. Objective: To explore the relationship between thyroid ADs and VVA signs and symptoms in a sample of postmenopausal women. Methods: Cross-sectional study including postmenopausal women not using systemic hormone therapy. VVA signs were assessed using the vaginal health index (VHI) and vulvar health index (VuHI); VVA symptoms were rated on a four-point severity scale. Results: Among 112 women enrolled, 28 had thyroid ADs. A significantly higher percentage of women with thyroid ADs showed vaginal atrophy (75 vs. 45.2%, p < .05). A greater proportion of women with thyroid ADs exhibited vulvar atrophy or both vaginal and vulvar atrophy, though these differences were not statistically significant. Women with thyroid ADs reported significantly higher scores for dryness, burning/itching, irritation/inflammation, and dyspareunia compared to those without it. A higher percentage of women with thyroid ADs experienced severe dyspareunia (45 vs. 20.6%, p < .05), severe burning/itching (33.3 vs. 9.1%, p < .05), and severe stress urinary incontinence (17.9 vs. 3.6%, p < 0.05). Conclusions: This study suggests that thyroid ADs may contribute to genital aging, with an apparent greater involvement in vaginal signs of atrophy. Women with thyroid ADs reported more severe VVA symptoms, but specific symptomatological clusters should be investigated in larger samples. Our data support the need to explore further the role of thyroid disorders in VVA.