Menopause and vulvar lichen sclerosus
VLS is more common during perimenopause and postmenopause. Understanding how both conditions interact—and how to manage them simultaneously—makes a real difference to quality of life.
Why VLS is more common during menopause
Menopause and VLS overlap significantly. VLS is most prevalent during perimenopause and postmenopause, suggesting a modulatory role of oestrogen in the disease. The drop in oestrogen that accompanies menopause may reduce the protection these hormones provide to vulvar tissue against the autoimmune inflammatory response.
However, this relationship is not directly causal: VLS also occurs in premenopausal women and in girls, indicating that hypoestrogenism is a modulatory factor, not the sole cause.
The problem of symptom overlap
Both VLS and the genitourinary syndrome of menopause (vulvovaginal atrophy) cause similar symptoms: dryness, itching, burning, and dyspareunia. When they coexist—which is common—treating only one of the conditions results in a partial response. It is important for the specialist to assess both.
The role of oestrogen in managing VLS during menopause
Hormone therapy in menopause has two forms of presentation that are relevant in the context of VLS:
Local topical oestrogens (vaginal)
Local topical oestrogens—in the form of a cream, pessary, or vaginal ring—act mainly on vaginal and vulvar tissue, with minimal systemic absorption. They are effective for the genitourinary syndrome of menopause—vulvovaginal atrophy—and can improve lubrication and the elasticity of vulvar tissue. They do not treat VLS itself, but they can improve symptoms shared by VLS and atrophy.
Systemic hormone therapy
Systemic hormone therapy—oral, transdermal, or via a ring—plays a role in the overall management of menopausal symptoms. Its effect on VLS specifically is not well established. It does not replace corticosteroid treatment for VLS, but it may complement it in patients with symptomatic menopause.
The decision to start hormone therapy in menopause should be made with the appropriate specialist, taking into account individual risk factors and the expected benefits.
How to manage VLS and menopause simultaneously
Patients with VLS during menopause often need an approach that combines:
> VLS treatment** — topical corticosteroids or regenerative medicine depending on response
> Treatment of the genitourinary syndrome** — local topical oestrogens if indicated
> Daily topical care** — hydration and vulvar oils adapted to postmenopausal skin
These treatments are not mutually exclusive—they can and should be combined when both conditions are present.