It is a very common experience at Menopause that dryness can cause discomfort, and that can fairly easily be dealt with.

However if it is vaginal atrophy it does need to be dealt with differently

What is it?

Vaginal atrophy can affect up to 50% of menopausal women and is when the walls of your vagina get thin, dry, and inflamed. This can happen when your body makes less oestrogen, such as during and after menopause.

This condition and its symptoms together are called genitourinary syndrome of menopause (GSM). You’ll notice it in both your vagina and urinary tract.

Many women are not aware that vaginal atrophy is a chronic condition, and may tend to resort to moisturisers and lubricants which can give temporary relief, but without addressing the underlying cause.

What are the symptoms?

You may have only a few symptoms, or not many of them, but among those you might notice are:

• Vaginal dryness or burning
• Itching in your genitals
• Unusual vaginal discharge
• More yeast infections
• Burning when you pee
• A need to pee often
• A hard time holding pee in (incontinence)
• More urinary tract infections (UTIs)
• Discomfort or bleeding during or after sex
• Less natural lubrication when you have sex

Dryness is usually the first sign. Many people have them after menopause. But you may have them in the years before that, a time called perimenopause. GSM is common: Up to 40% of people after menopause have symptoms.

What causes it?

The cause of vaginal atrophy is a drop in oestrogen levels and at menopause, that can fall by about 85%.

When your body has less oestrogen, your genital tissues become more fragile. Menopause is the most common reason for GSM, but oestrogen levels can also go down because of:

• Breastfeeding
• Anti-oestrogen medications
• Some birth control pills
• Surgery to remove both ovaries
• Chemotherapy
• Pelvic radiation therapy
• Hormone treatment

What can help?

One way to ease these problems is to have sex as women with regular sexual activity, by themselves or with a partner, tend to have milder cases of vaginal atrophy than those who don’t.

Sexual activity raises blood flow to the vagina and helps it stay elastic.

If you have GSM-related dryness and discomfort, especially when you have sex, using vaginal moisturisers or water-based lubricants may help. You use them every few days and just before intercourse.

Many women find 20-1 with its low oestrogen content when used vaginally is also helpful for dryness as well as other menopause symptoms.

If you’ve tried these methods and still have pain, you will need to talk to your doctor about other treatment options such as localised oestrogen as a cream or pessary.

Helpful information: 

Local oestrogen therapy using oestriol or oestradiol can be applied as pessaries, cream or a slow-release vaginal ring, the hormone being well-absorbed through the vaginal wall, but with minimal absorption into the body’s general circulation.

Complementary approaches such as phytoestrogens (eg soy, red clover and black cohosh isoflavones) can be useful and both oral vitamin E and the omega 3 in fish oils have been found in some trials to improve vaginal lubrication.

Hormone balance is key here, so check your oestrogen levels in relation to your dryness and using a combination cream of progesterone and oestrogen such as 20-1 can certainly be helpful but if this persists you need to speak to your doctor.