12th May 2024

A 57-year-old woman presents with a several-month history of vaginal dryness, itching, and dyspareunia.

A 57-year-old woman presents with a several-month history of vaginal dryness, itching, and dyspareunia. She also reports occasional spotting after intercourse. She is 5 years post-menopausal and has no significant medical history. On examination, vaginal mucosa appears thin, dry, and pale.

Which underlying mechanism is most likely responsible for her clinical presentation?