Understanding the Problem
If no one warned you that menopause could make your vagina feel dry, sore, or uncomfortable during sex, you're not alone. Over half of postmenopausal women experience these symptoms, yet they’re rarely discussed and often silently endured [1,2].
Many women believe this is just something they have to put up with. The truth? You don’t. These symptoms are common, but they are treatable.
What’s Causing It?
As oestrogen levels decline after menopause, the tissues of the vagina and vulva become thinner, drier, less elastic, and more fragile. Blood flow decreases, and natural lubrication diminishes.
These changes are part of a recognised medical condition called Genitourinary Syndrome of Menopause (GSM), which affects an estimated 50–70% of postmenopausal women [3]. GSM involves not just the vagina, but also the vulva, bladder, and urethra, and can significantly affect wellbeing, confidence, and intimacy.
While these changes are normal, they are not trivial. And they should not be ignored.
Recognising the Symptoms
The signs of vaginal and vulval atrophy can develop gradually and include:
- Vaginal dryness, itching, or burning
- Pain or discomfort during sex (dyspareunia)
- Loss of elasticity or thinning of the vaginal lips
- Increased urinary tract infections (UTIs)
- Urinary urgency or incontinence
- Watery, discoloured, or odorous discharge
- Bleeding after sex or exercise
Left untreated, these symptoms often persist or worsen over time [4,5].
Treatment Options: What Works and Why
1. Local Vaginal Oestrogen
Local oestrogen is a low-dose hormone therapy that directly targets affected tissues. It helps to:
- Rehydrate and thicken the vaginal lining
- Restore elasticity and improve blood flow
- Alleviate soreness, burning, and itching
- Make sex more comfortable
- Reduce urinary symptoms and UTIs [6,7]
Because it acts locally, only minimal amounts are absorbed into the bloodstream. This makes it safe for long-term use in most women [8].
Available Forms of Vaginal Oestrogen:
- Creams (e.g. estriol or oestradiol): applied using an applicator or finger
- Pessaries/tablets (e.g. Vagifem, Imvaggis) — inserted into the vagina
- Vaginal ring (e.g. Estring) — a soft ring placed inside the vagina for 90 days
Treatment typically starts with daily use for a few weeks, followed by a maintenance dose (usually twice a week). Your clinician will tailor the approach to your needs.
Is It Safe?
Yes — for the vast majority of women. Local oestrogen does not carry the same risks associated with systemic HRT. Even women with a history of breast cancer may be able to use it safely, under specialist supervision [9,10].
2. DHEA (Prasterone)
This is a daily vaginal pessary that is converted in the local tissues into oestrogen and testosterone. It can improve tissue health, increase lubrication, and support sexual function.
3. Non-Hormonal Options and Lifestyle Support
For women who prefer non-hormonal strategies or cannot use hormonal therapy:
- Vaginal moisturisers: used regularly to maintain hydration
- Lubricants: used during sex to reduce discomfort
- Avoid harsh soaps or perfumed products: these can irritate delicate tissue
- Allowing more time for arousal and foreplay: supports natural lubrication
When to Seek Help
If vaginal dryness or discomfort is affecting your quality of life, intimacy, or confidence, speak to one of our Voy Menopause clinicians.
These issues are treatable, and you do not have to tolerate them in silence.
¹Gandhi, J., et al. “Genitourinary Syndrome of Menopause: An Overview of Clinical Manifestations, Pathophysiology, Etiology, Evaluation, and Management.” American Journal of Obstetrics and Gynecology
, vol. 215, no. 6, 2016, pp. 704–11. https://www.ajog.org/article/S0002-9378(16)30518-X/fulltext
²Nappi, Rossella E., and Santiago Palacios. “Impact of Vulvovaginal Atrophy on Sexual Health.” Climacteric, vol. 17, no. 1, 2014, pp. 3–9. https://www.tandfonline.com/doi/full/10.3109/13697137.2013.871696
³Portman, David J., and Mickey L. Gass. “Genitourinary Syndrome of Menopause: New Terminology for Vulvovaginal Atrophy from the International Society for the Study of Women’s Sexual Health and The North American Menopause Society.” Menopause, vol. 21, no. 10, 2014, pp. 1063–68. https://journals.lww.com/menopausejournal/abstract/2014/10000/genitourinary_syndrome_of_menopause__new.6.aspx
⁴Kingsberg, Sheryl A., et al. “Vulvar and Vaginal Atrophy in Postmenopausal Women: Findings from the REVIVE Survey.” The Journal of Sexual Medicine, vol. 10, no. 7, 2013, pp. 1790–99. https://academic.oup.com/jsm/article-abstract/10/7/1790/6940054
⁵Cagnacci, Angelo, et al. “Lower Urinary Tract Symptoms and Their Relation to Vaginal Atrophy in Women across the Menopausal Age Span: Results from the ANGEL Multicentre Observational Study.” Maturitas, vol. 140, Oct. 2020, pp. 8–13. Elsevier, https://pubmed.ncbi.nlm.nih.gov/32972638/
⁶Suckling, Jane, et al. “Local Oestrogen for Vaginal Atrophy in Postmenopausal Women.” Cochrane Database of Systematic Reviews, no. 4, 2006, CD001500. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001500.pub2/full
⁷North American Menopause Society (NAMS). “The 2022 Hormone Therapy Position Statement of The North American Menopause Society.” Menopause, vol. 29, no. 7, 2022, pp. 767–94. https://journals.lww.com/menopausejournal/abstract/2022/07000/the_2022_hormone_therapy_position_statement_of_the.4.aspx
⁸Biglia, Nicoletta, et al. “Vaginal Atrophy in Breast Cancer Survivors: Attitude and Approaches among Oncologists.” Clinical Breast Cancer, vol. 17, no. 8, 2017, pp. 611–17. https://www.sciencedirect.com/science/article/pii/S1526820917300952
⁹Hussain, Ishrat, and Vikram Sinai Talaulikar. "A systematic review of randomised clinical trials–The safety of vaginal hormones and selective estrogen receptor modulators for the treatment of genitourinary menopausal symptoms in breast cancer survivors." Post Reproductive Health 29.4 (2023): 222-231. https://journals.sagepub.com/doi/full/10.1177/20533691231208473
