Beyond Estrogen Deficiency: Hormonal Influences, Diagnostic Challenges, and Integrated Management of Vulvar Dermatoses During Menopause

The menopausal transition is associated with significant endocrine, epithelial, and immunological changes that influence vulvar health and may complicate the recognition of inflammatory and autoimmune dermatological disorders. This narrative review aimed to analyze the relationship between menopausal hormonal alterations and vulvar dermatoses, emphasizing pathophysiological mechanisms, clinical manifestations, differential diagnosis, and evidence-based therapeutic strategies. A qualitative synthesis of 20 scientific publications was conducted, incorporating international clinical research, epidemiological investigations, reviews, and professional guidelines, including evidence from Latin America. The findings identified estrogen deficiency as an important contributor to epithelial fragility, reduced lubrication, altered vaginal microbiota, and genitourinary syndrome of menopause. However, these alterations frequently coexist with independent conditions, including lichen sclerosus, erosive lichen planus, contact dermatitis, lichen simplex chronicus, and genital psoriasis. Considerable overlap was observed in symptoms such as pruritus, burning, dryness, and dyspareunia, whereas characteristic morphological findings provided greater diagnostic differentiation. Epidemiological evidence demonstrated substantial variability in the reported prevalence of menopausal genitourinary symptoms, with relevant findings from a Brazilian population-based study. Therapeutic approaches differed according to the underlying condition, with local hormonal treatments and nonhormonal interventions primarily indicated for genitourinary syndrome of menopause, while topical anti-inflammatory agents remained central to the management of inflammatory dermatoses. The available evidence also highlighted uncertainties surrounding emerging therapeutic technologies and the limited representation of Latin American populations. In conclusion, vulvar disorders during the menopausal transition require comprehensive evaluation that distinguishes hormonal tissue changes from independent inflammatory diseases. An integrated dermatological, gynecological, and endocrinological approach is essential for accurate diagnosis, individualized treatment, and appropriate long-term clinical surveillance.