Ava Noir — Sexual WellnessWhat Is Vaginal Atrophy?
A clear guide to vaginal atrophy — now more accurately called genitourinary syndrome of menopause — the symptoms to know, its causes and the full range of treatments available.
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40–54%of post-menopausal women experience symptoms of vaginal atrophy (GSM)
Highly treatableeffective treatments range from over-the-counter products to prescription therapy
Underreportedmany women do not seek treatment — assuming it is inevitable or untreatable
Gets worse without treatmentunlike hot flushes, vaginal atrophy tends to progress over time unless treated
Vaginal atrophy — now known as genitourinary syndrome of menopause (GSM) — is one of the most common and most undertreated conditions affecting women in midlife and beyond. It is not inevitable, it is not untreatable and it does not have to be accepted as a permanent feature of ageing.The change in terminology from "vaginal atrophy" to "genitourinary syndrome of menopause" reflects a better understanding of the condition's full scope — it affects not just vaginal tissue but also the surrounding vulvar tissue and the urinary system. Understanding what is happening, recognising the symptoms and knowing what help is available is the first step toward effective management.
What Is Happening in the Body
Oestrogen is the hormone responsible for maintaining the health of vaginal, vulvar and urinary tract tissues. It keeps the vaginal lining thick, well-lubricated, elastic and resistant to infection. When oestrogen levels decline — most commonly during and after menopause — these tissues gradually thin, dry out and become more fragile and inflamed. The vaginal walls lose elasticity and the vaginal canal may shorten and narrow over time. The vulvar skin also becomes thinner and more sensitive.
These changes typically begin during perimenopause and progress after menopause. Crucially, unlike hot flushes which often improve over time, vaginal atrophy tends to worsen progressively without treatment. Starting treatment early — before symptoms become severe — is advantageous.
Symptoms
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Vaginal dryness — typically the first sign
- Vaginal burning or itching
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Pain or discomfort during sex (dyspareunia)
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Light bleeding after sex from fragile tissue
- Unusual vaginal discharge
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Urinary symptoms — frequent urination, urgent need to urinate, burning when urinating, recurrent urinary tract infections, urinary incontinence
Not all women experience all symptoms. Some experience only vaginal symptoms, others primarily urinary symptoms, many have a combination.
LubricantFirst-line relief for sex-related discomfort. A quality glycerin-free, silicone-based lubricant provides the longest-lasting friction relief during penetration. Available over the counter.
Vaginal MoisturiserUsed regularly 2–3 times weekly for ongoing tissue hydration and daily comfort. Absorbed into tissue. Reduces itching and irritation between sexual activity. Available over the counter.
Vaginal OestrogenTreats the underlying tissue changes rather than just managing symptoms. Applied locally — cream, gel, pessary or ring — with minimal systemic absorption. Available over the counter in England; on prescription elsewhere in the UK.
Systemic HRTAddresses GSM alongside other menopause symptoms (hot flushes, mood changes, sleep disturbance). Carries more considerations than local vaginal oestrogen. Discuss with GP or menopause specialist.
Regular Sexual ActivityRegular sexual activity — partnered or solo — increases blood flow to vaginal tissue and helps maintain elasticity. Sexual activity and vaginal dilators are both recommended alongside other treatments for GSM.
Do Not Wait to Seek HelpUnlike hot flushes, GSM does not improve without treatment and tends to worsen over time. Starting treatment early produces better outcomes. This is a recognised medical condition — not something to manage silently.
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Who Gets Vaginal Atrophy
The primary risk factor is declining oestrogen. This most commonly occurs during perimenopause and menopause, but also during breastfeeding, after surgical removal of the ovaries, during chemotherapy or pelvic radiotherapy for cancer, and as a side effect of certain cancer hormone therapies.
Around 15% of women experience symptoms before menopause. Post-menopause, between 40% and 54% of women experience bothersome GSM symptoms — yet the condition remains significantly underdiagnosed and undertreated because many women do not realise their symptoms have a name, a cause and effective treatments available.
Vaginal Oestrogen: The Most Effective Non-Surgical Treatment
For women with moderate to severe GSM, vaginal oestrogen is considered the most effective treatment. It comes in several forms — creams, gels, pessaries and rings — that deliver oestrogen directly to the vaginal tissues. Because the oestrogen acts locally rather than being distributed throughout the body, it carries significantly fewer systemic risks than oral HRT and is suitable for many women who cannot take systemic hormone therapy, including many women with a history of breast cancer. A GP can discuss the appropriate form and dosage for individual circumstances.
Frequently Asked Questions
What is vaginal atrophy?Vaginal atrophy — now more accurately called genitourinary syndrome of menopause (GSM) — is a condition in which declining oestrogen causes the vaginal tissue to thin, dry out and become more fragile. It affects 40–54% of post-menopausal women and also occurs during breastfeeding and after certain cancer treatments.
What are the symptoms of vaginal atrophy?The most common symptoms are vaginal dryness, burning, itching, pain during sex and light bleeding after sex. Urinary symptoms — frequent urination, urgency, burning when urinating and recurrent UTIs — are also part of the syndrome. Not all women experience all symptoms.
Is vaginal atrophy treatable?Yes — very effectively. Treatments range from over-the-counter lubricants and vaginal moisturisers for symptom relief, to vaginal oestrogen therapy which treats the underlying tissue changes. Unlike hot flushes, GSM tends to worsen without treatment, so seeking help early is worthwhile.
Does vaginal atrophy go away on its own?No — unlike some menopause symptoms that improve over time, vaginal atrophy typically worsens without treatment as the tissue continues to thin and dry in the absence of oestrogen. This is a key reason why seeking treatment rather than waiting is the recommended approach.
What is the best treatment for vaginal atrophy?For mild symptoms, a lubricant during sex and a regular vaginal moisturiser for daily comfort. For moderate to severe symptoms, vaginal oestrogen — available in cream, gel, pessary or ring form — is considered the most effective treatment and is available over the counter in England or on prescription elsewhere in the UK.