Hot flashes get the attention. But one of the most common menopause symptoms is one women rarely raise with their doctor: vaginal dryness, irritation and discomfort.
What it is
The clinical name is genitourinary syndrome of menopause (GSM). As estrogen falls, the tissues of the vagina, vulva, urethra and bladder become thinner, drier and less elastic. Symptoms can include:
- Dryness, burning or itching
- Pain during sex
- Needing to urinate more urgently or often
- More frequent urinary tract infections
Estimates suggest around half of postmenopausal women are affected.
How it differs from hot flashes
Hot flashes usually ease with time. GSM tends to get worse without treatment, because the underlying tissue changes continue. Many women assume it’s simply part of ageing and stay quiet — surveys consistently find most women with symptoms never receive treatment.
Treatment options
Vaginal moisturisers, used a few times a week, help maintain moisture regardless of sexual activity.
Lubricants reduce friction and pain during sex. Water- and silicone-based options are widely available.
Low-dose vaginal estrogen — creams, tablets or a ring — treats the underlying tissue changes and is highly effective for dryness, pain and urinary symptoms. Because the dose is low and acts locally, very little reaches the bloodstream. It’s considered safe for most women, including many who can’t take systemic hormone therapy, though women with a history of breast cancer should discuss it with their oncologist.
Other prescription options include vaginal DHEA and ospemifene, an oral medication.
Pelvic floor physical therapy can help when pain has led to muscle tension.
Don’t wait
If sex has become painful or urinary symptoms have changed, raise it — clinicians hear this often, and effective, low-risk treatments exist. It’s also worth reporting any postmenopausal bleeding promptly, which always needs investigation.