This is an expected finding among menopausal women not taking estrogen replacement therapy.

• If this is the only abnormal finding and the patient has no symptoms, it can be safely ignored.
• If the patient complains of vaginal dryness, irritation, painful intercourse, vaginal discharge, odor, or other symptoms, then the Pap finding of atrophic vaginitis is helpful in determining the cause.
• If the Pap smear has other abnormalities, treating the patient for 2-3 weeks with Premarin 0.625 mg PO daily and then repeating the Pap will often result in the other abnormality disappearing.

This is also occasionally seen in women on long-term hormonal contraception, whose circulating estradiol levels are quite low. If the patient has no other symptoms, no treatment is needed.